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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.

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


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.


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

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