Key result
In STEMI patients treated with primary PCI, low-molecular-weight heparins significantly reduced all-cause mortality (RR 0.51) and major bleeding (RR 0.68) compared to unfractionated heparin.
Why the study?
Does low-molecular-weight heparin reduce mortality and major bleeding compared to unfractionated heparin in STEMI patients undergoing PCI?
Meta-Analysis (n=16,286)
Does low-molecular-weight heparin reduce mortality and major bleeding compared to unfractionated heparin in STEMI patients undergoing PCI?
LMWHs demonstrate superior efficacy and safety over standard unfractionated heparin in STEMI patients undergoing primary PCI, challenging current guideline recommendations.
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 16,286 patients were included. The median follow-up was 2 months 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.
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Navarese et al. (2011) conducted a meta-analysis in ST-elevation myocardial infarction (STEMI) (n=16,286). Low-molecular-weight heparins (LMWHs) vs. Unfractionated heparin (UFH) was evaluated on All-cause mortality in the primary PCI group (RR 0.51, 95% CI 0.41-0.64, p=<0.001). In STEMI patients treated with primary PCI, low-molecular-weight heparins significantly reduced all-cause mortality (RR 0.51) and major bleeding (RR 0.68) compared to unfractionated heparin.
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