Enoxaparin produced stable therapeutic anti-Xa levels with minimal effect on aPTT, whereas unfractionated heparin produced wide swings often outside desired levels.
RCT (n=20)
Randomized
Does enoxaparin improve the stability of anticoagulant effect compared to unfractionated heparin in patients with acute myocardial infarction receiving fibrinolytics?
Enoxaparin provides a more stable anticoagulant effect than unfractionated heparin when used as an adjunct to fibrinolytics in acute myocardial infarction.
BACKGROUND: Antithrombotic adjuncts to fibrinolytic drugs for acute myocardial infarction increase the rate and speed of infarct artery recanalization. HYPOTHESIS: A low-molecular-weight heparin might be preferable to unfractionated heparin for this indication, as it has been shown to be in several other thrombus-related vascular disorders. METHODS: We performed a pilot study in 20 patients, all receiving aspirin and recombinant tissue plasminogen activator. Randomization was to standard dose intravenous unfractionated heparin or enoxaparin (the first dose given intravenously and followed by a subcutaneous administration). The endpoint was stability of anticoagulant effect. RESULTS: Enoxaparin produced stable therapeutic anti-Xa levels with minimal effect on activated partial thromboplastin times. Unfractionated heparin produced wide swings of these parameters, often outside desired levels. CONCLUSIONS: Enoxaparin may be a better antithrombotic agent than conventional unfractionated heparin when used in conjunction with fibrinolytics.
Ross et al. (Sat,) conducted a rct in Acute myocardial infarction (n=20). Enoxaparin vs. Standard dose intravenous unfractionated heparin was evaluated on Stability of anticoagulant effect. Enoxaparin produced stable therapeutic anti-Xa levels with minimal effect on aPTT, whereas unfractionated heparin produced wide swings often outside desired levels.
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