Meta-analysis of randomized trials comparing enoxaparin versus unfractionated heparin as adjunctive therapy to fibrinolysis in ST-elevation acute myocardial infarction

Abstract

Recent investigations have shown that enoxaparin is a better choice than unfractionated heparin in non–ST-segment acute coronary syndromes1,2 and suggested that it may also be a better choice in ST-segment elevation acute myocardial infarction (AMI).3–8 The third Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT-3) trial demonstrated that enoxaparin coupled with weight-adjusted bolus tenecteplase decreased the composite end point of death, reinfarction, and refractory ischemia by 16% compared with unfractionated heparin.4 By easing their administration, bolus fibrinolytic agents and a bolus or subcutaneous injection of low-molecular-weight heparin can facilitate patient management in busy emergency departments and enhance the opportunities of earlier administration, such as prehospital fibrinolytic programs. This review of available data was performed using meta-analysis methods to provide further information on the consistency of efficacy and safety data with enoxaparin as an adjunctive therapy to fibrinolysis.