Skip Navigation


European Heart Journal Advance Access originally published online on April 24, 2007
European Heart Journal 2007 28(9):1066-1071; doi:10.1093/eurheartj/ehm081
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
28/9/1066    most recent
ehm081v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (17)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by White, H. D.
Right arrow Articles by Antman, E. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by White, H. D.
Right arrow Articles by Antman, E. M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Enoxaparin vs. unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction in elderly and younger patients: results from ExTRACT-TIMI 25

Harvey D. White1,*, Eugene Braunwald2, Sabina A. Murphy2, Ashok J. Jacob3, Nina Gotcheva4, Leonid Polonetsky5 and Elliott M. Antman2

1 Green Lane Cardiovascular Service, Auckland City Hospital, Auckland 1030, New Zealand
2 TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
3 St. John's Hospital, Livingston, West Lothian, UK
4 Cardiology Department, National Heart Center, Sofia, Bulgaria
5 Republic Research-Practical Center ‘Cardiology’, Minsk, Belarus

Received 18 December 2006; revised 22 February 2007; accepted 8 March 2007; online publish-ahead-of-print 24 April 2007.

* Corresponding author. Tel: +64 9 630 9992; fax: +64 9 630 9915. E-mail address: harveyw{at}adhb.govt.nz

Aims: To determine the effects of age on outcomes in patients with STEMI treated with a strategy of enoxaparin (ENOX) vs. unfractionated heparin (UFH).

Methods and results: In the ExTRACT-TIMI 25 trial, 20 479 patients with STEMI were randomized in a double-blind fashion to UFH or ENOX. A novel reduced dose of ENOX was administered to patients ≥75 years, and a reduced dose in those with an estimated creatinine clearance of < 30 mL/min. Anti-Xa levels were measured in a subset of patients (n = 73). The exposure to anti-Xa over time was lower in the elderly (AUC0–12 h P < 0.0001; AUCsteady-state P = 0.0046). The relative risk reduction (RR) with ENOX on the primary endpoint, i.e. death or non-fatal recurrent myocardial infarction, was greater in patients < 75 years (20%) than > 75 years (6%), but the absolute benefits were similar. When compared with UFH, ENOX was associated with an RR of 1.67 for major bleeding, but the magnitude of the excess risk tended to be lower (RR = 1.15) in patients ≥ 75 years assigned to ENOX.

Conclusion: A dose reduction of ENOX in the elderly appears to be helpful in ameliorating bleeding risk. A strategy of ENOX was superior to UFH in both young and elderly patients with STEMI treated with fibrinolysis.

Key Words: ExTRACT-TIMI 25 • Enoxaparin • Unfractionated heparin • Age


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 The Annals of PharmacotherapyHome page
E. A Nutescu, S. A Spinler, A. Wittkowsky, and W. E Dager
Low-Molecular-Weight Heparins in Renal Impairment and Obesity: Available Evidence and Clinical Practice Recommendations Across Medical and Surgical Settings
Ann. Pharmacother., June 1, 2009; 43(6): 1064 - 1083.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
F. Van de Werf
Year 2008 ESC ST-segment elevation myocardial infarction guidelines: implications for the interventional cardiologist--from evidence to recommendations and practice
Eur. Heart J. Suppl., June 1, 2009; 11(suppl_C): C31 - C37.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
Authors/Task Force Members, F. Van de Werf, J. Bax, A. Betriu, C. Blomstrom-Lundqvist, F. Crea, V. Falk, G. Filippatos, K. Fox, K. Huber, et al.
Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology:
Eur. Heart J., December 1, 2008; 29(23): 2909 - 2945.
[Full Text] [PDF]

Home page
 ChestHome page
S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington
Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest, June 1, 2008; 133(6_suppl): 708S - 775S.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
American College of Cardiology/American Heart Asso, Developed in Collaboration With the Canadian Cardi, Endorsed by the American Academy of Family Physici, 2007 Writing Group to Review New Evidence and Upda, E. M. Antman, M. Hand, P. W. Armstrong, E. R. Bates, L. A. Green, L. K. Halasyamani, et al.
2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction
J. Am. Coll. Cardiol., January 15, 2008; 51(2): 210 - 247.
[Full Text] [PDF]

Home page
 CirculationHome page
E. M. Antman, M. Hand, P. W. Armstrong, E. R. Bates, L. A. Green, L. K. Halasyamani, J. S. Hochman, H. M. Krumholz, G. A. Lamas, C. J. Mullany, et al.
2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the Canadian Cardiovascular Society Endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee
Circulation, January 15, 2008; 117(2): 296 - 329.
[Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.