[Application of enoxaparin simultaneously with fibrinolysis in patients with acute myocardial infarction with ST-elevation].
BACKGROUND
Applied simultaneously with fibrinolytic therapy, low-molecular heparin enoxaparin is showing the potential of improving efficacy with rare adverse effects. Our objective was to investigate if enoxaparin with streptokinase (SK) in patients with acute myocardial infarction (AMI) had better effect than unfractioned heparin (UFH).


METHODS
The patients with AMI with ST elevation where SK was applied, were divided into two groups: 1. In the study group (N=32, SK+E) both SK and enoxaparin were administered (E, 30 mg intravenously before SK, then after SK 80 mg subcutaneously every 12 hours for 3 days); 2. The patients of the control group were given continuous infusion of UFH 4 hours after SK (1000 i.j. per hour, 3 days). Two groups were similar regarding average age, previous coronary events and diabetes mellitus.


RESULTS
The reperfusion, depending mostly on fibrinolytic therapy, was successful in both groups (71.9% vs. 65.8%). The recurrent ischemia was less frequent in the group where enoxaparin was used (18.8% vs. 40.6%, p=0.055), as well as heart failure (15.6% vs. 53.2%, p=0,095). There was no difference in adverse effects.


CONCLUSIONS
Enoxaparin used simultaneously with streptokinase in patients with AMI with ST elevation was safe and effective. The recurrent ischemia, the parameter of "infarcted" coronary artery reoclusion, is less frequent in patients who had enoxaparin than unfractioned heparin with fibrinolytic therapy.
Despotović
Nebojsa
N
Centar za kardiovaskularne bolesti, Klinicko-bolnicki centar "Zvezdara", Beograd. ndsp@beotel.yu
Loncar
Goran
G
Nikolić-Despotović
Maja
M
Ilić
Marjan
M
Dimković
Sinisa
S
Mirić
Milutin
M
D000368:Aged; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy
D017984:Enoxaparin; D005343:Fibrinolytic Agents; D013300:Streptokinase