Percutaneous Coronary Intervention in Patients Receiving Enoxaparin or Unfractionated Heparin After Fibrinolytic Therapy for ST-Segment Elevation Myocardial Infarction in the ExTRACT-TIMI 25 Trial

Gibson, C. Michael; Murphy, Sabina A.; Montalescot, Gilles; Morrow, David A.; Ardissino, Diego; Cohen, Marc; Gulba, Dietrich C.; Kracoff, Oscar H.; Lewis, Basil S.; Roguin, Nathan; Antman, Elliott M.; Braunwald, Eugene; Investigators, ExTRACT-TIMI

doi:10.1016/j.jacc.2007.01.093

Cited by 109 publications

(66 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6,7,70,76,77 When moving to PCI after fibrinolytic therapy, those patients who received upstream UFH or enoxaparin can continue to receive those anticoagulants in a seamless fashion (i.e., without crossover to another agent) using the dosing regimens listed in the recommendations. 73 On the basis of the reports of catheter thrombosis with fondaparinux alone during primary PCI in OASIS-6 and the experience with fondaparinux in the OASIS-5 trial, 78 the writing group thought fondaparinux should not be used as the sole anticoagulant during PCI but should be coupled with an additional agent that has anti-IIa activity to ameliorate the risk of catheter complications. Although bivalirudin and UFH are potential options for supplemental anticoagulation with fondaparinux, the available experience, albeit limited, is largely with UFH.…”

Section: Resultsmentioning

confidence: 99%

“…UFH was dosed according to the activated clotting time (ACT), using a target of 200 seconds for patients receiving a GP IIb/IIIa inhibitor and 250 seconds for those not receiving a GP IIb/IIIa inhibitor. 73 The main observations (Table 9) were the same whether the results were analyzed by intention to treat or by the actual anticoagulant received during the procedure (blinded study or open-label anticoagulant if PCI was performed after Day 8). 73 …”

Section: Ancillary Therapymentioning

confidence: 99%

“…73 The main observations (Table 9) were the same whether the results were analyzed by intention to treat or by the actual anticoagulant received during the procedure (blinded study or open-label anticoagulant if PCI was performed after Day 8). 73 …”

Section: Ancillary Therapymentioning

confidence: 99%

See 2 more Smart Citations

2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction

Antman¹,

Hand²,

Armstrong³

et al. 2008

Circulation

Self Cite

1,171

381

View full text Add to dashboard Cite

Section: Resultsmentioning

confidence: 99%

Section: Ancillary Therapymentioning

confidence: 99%

See 1 more Smart Citation

2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction

Antman¹,

Hand²,

Armstrong³

et al. 2008

Circulation

Self Cite

1,171

381

View full text Add to dashboard Cite

“…For patients with STEMI to be treated with fibrinolysis, 17 studies supported enoxaparin over UFH (LOE1 336,[387][388][389][390][391][392][393] ; LOE 2 341,394,395,396 ; LOE 4 397 ; LOE 5 393,396,398 -401 ) Twelve other studies were neutral comparing enoxaparin and UFH. [402][403][404][405][406][407][408][409][410][411] Reviparin.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

View full text Add to dashboard Cite

These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

show abstract

“…96 The Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment (EXTRACT-TIMI 25) trial demonstrated reduced rates of reinfarction with the low-molecular-weight heparin enoxaparin compared with unfractionated heparin in patients receiving fibrinolytic therapy and in those undergoing PCI after fibrinolysis. 97,98 This agent has not been meaningfully studied in the primary PCI setting, however. The selective factor Xa inhibitor fondaparinux was randomized against unfractionated heparin in 3788 patients undergoing primary PCI in the placebo-controlled, double-blind Organization to Assess Strategies for Ischemic Syndromes (OASIS-6) trial.…”

Section: Adjunctive Antiplatelet and Antithrombin Pharmacologymentioning

confidence: 99%

Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

Stone

2008

Circulation

View full text Add to dashboard Cite

ardiovascular disease is the most common cause of mortality in most developed nations; Ϸ838 000 inhospital discharges in the United States in 2005 were for acute myocardial infarction, 29% to 47% of which were acute ST-segment-elevation myocardial infarction (STEMI). 1 The case fatality rate of STEMI has fallen dramatically in the last 3 decades, in part because of the widespread use of reperfusion therapy. 1-4 STEMI is in most cases due to rupture of an inflamed thin-capped fibroatheroma containing a lipid-rich necrotic core with superimposed secondary thrombosis resulting in coronary artery occlusion. 5,6 From the seminal demonstration by Reimer et al 7 that canine coronary occlusion results in a several-hour wave front of necrosis spreading from the subendocardial to the subepicardial myocardium arose the hypothesis that timely restoration of flow in the occluded coronary artery would salvage jeopardized myocardium and enhance survival. Effective reperfusion in STEMI can be achieved by either fibrinolytic therapy or primary percutaneous coronary intervention (PCI) without antecedent fibrinolysis (also generally known as primary angioplasty). Fibrinolysis and PCI also may be combined in a variety of ways, depending on the timing of PCI after fibrinolytic administration, the clinical condition of the patient, and whether PCI is applied routinely or selectively after lytic therapy. Randomized trials have collectively demonstrated enhanced survival and freedom from major adverse cardiovascular events with primary PCI compared with fibrinolysis, and as a result, the expeditious performance of primary PCI has become the preferred reperfusion modality for patients with STEMI presenting at appropriately equipped centers.The introduction of new devices such as bare metal stents (BMS) and drug-eluting stents (DES) and novel potent antiplatelet and antithrombotic agents have transformed the interventional approach to the patient with STEMI. Important studies have been completed that have addressed previously unsettled issues such as the importance of time to intervention and the utility of late reperfusion. It is thus appropriate and timely to review the data underlying the contemporary interventional approach to STEMI. The first part of this 2-part series will review the essentials of primary PCI in STEMI, including comparison with fibrinolytic therapy, the impact of PCI-related delays, the evidence for and against delayed infarct artery intervention, the role of BMS and DES, appropriate use of adjunctive antiplatelet and antithrombotic agents, and strategies to expand access to primary PCI, including angioplasty without surgical backup and interhospital transfer. Part 2 reviews interventional strategies after fibrinolytic therapy, discusses volume-quality relationships for PCI outcomes, offers summary recommendations for the patient presenting with STEMI at hospitals with and without interventional facilities, and reviews recent and ongoing investigations to further improve outcomes after catheterbased reperfusion the...

show abstract

Percutaneous Coronary Intervention in Patients Receiving Enoxaparin or Unfractionated Heparin After Fibrinolytic Therapy for ST-Segment Elevation Myocardial Infarction in the ExTRACT-TIMI 25 Trial

Cited by 109 publications

References 17 publications

2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction

2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction

Part 9: Acute Coronary Syndromes

Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

Contact Info

Product

Resources

About