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Angiology. 2017 Jan;68(1):29-39. Epub 2016 Feb 9.

Intravenous Enoxaparin Versus Unfractionated Heparin in Elderly Patients Undergoing Primary Percutaneous Coronary Intervention: An Analysis of the Randomized ATOLL Trial.

Author information

1
UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
2
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
3
Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
4
Department of Emergency Medicine, Pennsylvania Hospital, Philadelphia, PA, USA.
5
Emergency Department, Lille University Hospital, Lille, France.
6
Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany.
7
3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
8
ACTION Study Group, Unité de Recherche Clinique, Hôpital Lariboisière (APHP), Paris, France.
9
UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France gilles.montalescot@aphp.fr.

Abstract

Elderly (≥75 years old) patients with ST-segment elevation myocardial infarction (STEMI) have higher ischemic and bleeding risk compared with those <75 years old. We investigated the efficacy and safety of intravenous (IV) enoxaparin versus IV unfractionated heparin (UFH) in elderly patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. A prespecified analysis of the Acute Myocardial Infarction Treated with Primary Angioplasty and Intravenous Enoxaparin or Unfractionated Heparin to Lower Ischemic and Bleeding Events at Short- and Long-term Follow-up (ATOLL) study was performed examining the 30-day outcomes in the elderly patients. Of the 165 elderly patients in the ATOLL study, 85 patients received IV enoxaparin 0.5 mg/kg and 80 patients received IV UFH. Intravenous enoxaparin did not reduce the primary end point, the main secondary efficacy end point, major bleeding, major or minor bleeding, and all-cause mortality compared with IV UFH. The rate of minor bleeding (5.9% vs 22.8%, P adjusted = .01) was significantly lower with IV enoxaparin compared with IV UFH. Intravenous enoxaparin appears to be a safe alternative to IV UFH in primary PCI of the elderly patients with STEMI.

KEYWORDS:

aged; enoxaparin; heparin; myocardial infarction; percutaneous coronary intervention

PMID:
26861858
DOI:
10.1177/0003319716629541
[Indexed for MEDLINE]

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