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Low-Molecular-Weight Heparin as an Adjunct to Thrombolysis in ST Elevation Myocardial Infarction
Daniel J. Quinlan, MBBS;
John W. Eikelboom, MBBS, MSc, FRACP
Arch Intern Med. 2009;169(12):1163-1164.
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The Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment (ExTRACT)–Thrombolysis in Myocardial Infarction (TIMI)-25 study1 demonstrated that the administration of enoxaparin sodium, 30 mg intravenously, followed by subcutaneous injections of 1 mg/kg twice daily (dose modified in patients 75 years or older), compared with intravenous unfractionated heparin (UFH), 60 U/kg bolus (maximum 4000 U), followed by 12 U/kg/h (initial maximum, 1000 U/h, and subsequently adjusted to maintain an activated partial thromboplastin time of 1.5-2.0 times the control value), reduced the risk of nonfatal reinfarction in patients with ST elevation myocardial infarction (STEMI) treated with thrombolysis. Because the ExTRACT-TIMI 25 study seems likely to be the last large trial evaluating the efficacy and safety of low-molecular-weight heparin (LMWH) in patients with STEMI, we added the results of this pivotal 20 000 patient trial to our meta-analysis published in 2005.2 Our updated . . . [Full Text of this Article] AUTHOR INFORMATION
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