Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction: A meta-analysis

E. P. Navarese, G. De Luca, F. Castriota, M. Kozinski, P. A. Gurbel, C. M. Gibson, F. Andreotti, A. Buffon, J. M. Siller-Matula, A. Sukiennik, S. De Servi, J. Kubica

Research output: Contribution to journalArticle

Abstract

Background: The aim of the current study was to perform two separate meta-analyses of available studies comparing low-molecular-weight heparins (LMWHs) vs. unfractionated heparin (UFH) in ST-elevation myocardial infarction (STEMI) patients treated (i) with primary percutaneous coronary intervention (pPCI) or (ii) with PCI after thrombolysis. Methods: All-cause mortality was the pre-specified primary endpoint and major bleeding complications were recorded as the secondary endpoints. Relative risk (RR) with a 95% confidence interval (CI) and absolute risk reduction (ARR) were chosen as the effect measure. Results: Ten studies comprising 16286 patients were included. The median follow-up was 2months for the primary endpoint. Among LMWHs, enoxaparin was the compound most frequently used. In the pPCI group, LMWHs were associated with a reduction in mortality [RR (95% CI)=0.51 (0.41-0.64), P<0.001, ARR=3%] and major bleeding [RR (95% CI)=0.68 (0.49-0.94), P=0.02, ARR=2.0%] as compared with UFH. Conversely, no clear evidence of benefits with LWMHs was observed in the PCI group after thrombolysis. Meta-regression showed that patients with a higher baseline risk had greater benefits from LMWHs (r=0.72, P=0.02). Conclusions: LMWHs were associated with greater efficacy and safety than UFH in STEMI patients treated with pPCI, with a significant relationship between risk profile and clinical benefits. Based on this meta-analysis, LMWHs may be considered as a preferred anticoagulant among STEMI patients undergoing pPCI.

Original languageEnglish (US)
Pages (from-to)1902-1915
Number of pages14
JournalJournal of Thrombosis and Haemostasis
Volume9
Issue number10
DOIs
StatePublished - Oct 1 2011

Keywords

  • Low-molecular-weight heparin
  • Percutaneous coronary intervention
  • ST-elevation myocardial infarction
  • Unfractionated heparin

ASJC Scopus subject areas

  • Hematology

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    Navarese, E. P., De Luca, G., Castriota, F., Kozinski, M., Gurbel, P. A., Gibson, C. M., Andreotti, F., Buffon, A., Siller-Matula, J. M., Sukiennik, A., De Servi, S., & Kubica, J. (2011). Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction: A meta-analysis. Journal of Thrombosis and Haemostasis, 9(10), 1902-1915. https://doi.org/10.1111/j.1538-7836.2011.04445.x