009: Comparison of bleeding complications and three-year survival of low molecular weight heparin versus unfractioned heparin for acute myocardial infarction. The FAST-MI registry

Abstract

Recent clinical studies suggest that low molecular weight heparin (LMWH) could be an effective and safe alternative to unfractionated heparin (UFH) for patients with acute myocardial infarction (AMI). To assess the impact of the choice of anticoagulant (LMWV vs. UFH) on bleeding, the need for blood transfusion and three-year clinical outcomes in patients with AMI from the FAST-MI registry. FAST-MI is a nationwide registry carried out in France over a 1-month period in 2005, including consecutive patients with AMI admitted to intensive care unit <48h from symptom onset in 223 participating centers. 2854 patients treated with heparins were included. The risk of major bleeding or transfusion (3.0% vs. 7.0%) and in-hospital death (3.2% vs 9.2%) was lower with LMWH compared with UFH, a difference that persisted after multivariate adjustment (OR=0.51, 95% CI: 0.34-0.76 and OR=0.53, 95% CI: 0.37-0.76, respectively). Three-year survival and stroke and reinfarction-free survival were also higher with LMWH compared with UFH (adjusted HR =0.73, 95% CI: 0.61-0.86 and HR =0.73, 95% CI: 0.62-0.85, respectively). In two cohorts of patients matched on a propensity score for getting LMWH and with similar baseline characteristics (834 patients per group), major bleeding and transfusion were lower while three-year survival was signicantly higher in patients receiving LMWH. The present data suggest that the use of LMWH in AMI patients may have a better benefit/risk profile than UFH with in terms of bleeding, need for transfusion, and long term survival.