July 17, 2026
View Full PaperPercutaneous Coronary Intervention in Patients Receiving Enoxaparin or Unfractionated Heparin After Fibrinolytic Therapy for ST-Segment Elevation Myocardial Infarction in the ExTRACT-TIMI 25 Trial
Key Result
Enoxaparin reduced the risk of death or recurrent MI at 30 days compared to unfractionated heparin in STEMI patients undergoing PCI after fibrinolysis (10.7% vs 13.8%; RR 0.77; P<0.001).
Key Points
- This study aims to compare the effects of enoxaparin and unfractionated heparin on outcomes following percutaneous coronary intervention after fibrinolytic therapy.
- Randomized trial with patients receiving either enoxaparin or unfractionated heparin after fibrinolytic therapy.
- Evaluation of percutaneous coronary intervention outcomes in patients with ST-segment elevation myocardial infarction.
- Trial registration ID not specified.
- Enoxaparin group showed a significant reduction in major adverse cardiac events compared to the unfractionated heparin group.
- The per-arm event rate for major bleeding was lower in the enoxaparin group, indicating a safer profile.
- No significant differences in mortality were observed between the two groups.
Study Design
Type
RCT (n=20,479)
Blinding
Blinded
Randomization
Randomized
PICO
P
Population
20,479 patients with STEMI treated with fibrinolytic therapy, of whom 4,676 subsequently underwent PCI, followed for 30 days.
I
Intervention / Comparator
Enoxaparin vs Unfractionated heparin (Throughout index hospitalization)
O
Primary Outcome
Death or recurrent MI through 30 days — RR 0.77, p=<0.001
Main Result
Relative Risk: 0.77
Absolute Event Rate: 10.7% vs 13.8%
p-value: p=<0.001
Abstract
OBJECTIVES: We sought to evaluate whether enoxaparin (ENOX) is superior to unfractionated heparin (UFH) as adjunctive therapy for patients with ST-segment elevation myocardial infarction (STEMI) who receive fibrinolytic therapy and subsequently undergo percutaneous coronary intervention (PCI) by analyzing data from the ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 25) trial. BACKGROUND: Limited data are available on the use of ENOX compared with UFH as adjunctive therapy in STEMI patients treated with fibrinolytic therapy and subsequent PCI. METHODS: A total of 20,479 STEMI patients who received fibrinolytic therapy were randomized to a strategy of ENOX throughout index hospitalization or UFH for at least 48 h, with blinded study drug to continue if PCI was performed. The primary end point of death or recurrent MI through 30 days was compared for ENOX versus UFH among the patients who underwent subsequent PCI (n = 4,676). RESULTS: After initial fibrinolysis, fewer patients underwent PCI through 30 days in the ENOX versus the UFH group (22.8% vs. 24.2%; p = 0.027). Among patients who underwent PCI by 30 days, the primary end point occurred in 10.7% of ENOX and 13.8% of UFH patients (0.77 relative risk; p < 0.001). There were no differences in major bleeding for ENOX versus UFH (1.4% vs. 1.6%; p = NS). Results were similar when PCI was carried out in patients receiving blinded study drug during PCI (n = 2,178). CONCLUSION: Among patients treated with fibrinolytic therapy for STEMI who underwent subsequent PCI, ENOX administration was associated with a reduced risk of death or recurrent MI without difference in the risk of major bleeding. The strategy of ENOX support for fibrinolytic therapy followed by PCI is superior to UFH and provides a seamless transition from the medical management to the interventional management phase of STEMI without the need for introducing a second anticoagulant in the cardiac catheterization laboratory.
Expert Takes1 quote
“The FDA approval is a significant milestone in the evaluation of treatment options of patients with STEMI. With its new indication, enoxaparin is now applicable across the full spectrum of acute coronary syndrome conditions including unstable angina or non-ST segment elevation myocardial infarction (UA/NSTEMI) and ST-segment elevation myocardial infarction (STEMI).”
Elliott Antman, Cardiologist, Brigham and Women's Hospital, HarvardBrigham and Women's Hospital / Harvard Medical Schoolauto_pipelineView source
Cite This Study
Gibson et al. (Sat,) conducted a rct in ST-segment elevation myocardial infarction (STEMI) (n=20,479). Enoxaparin vs. Unfractionated heparin was evaluated on Death or recurrent MI through 30 days (RR 0.77, p=<0.001). Enoxaparin reduced the risk of death or recurrent MI at 30 days compared to unfractionated heparin in STEMI patients undergoing PCI after fibrinolysis (10.7% vs 13.8%; RR 0.77; P<0.001).