title: Intravenous Enoxaparin Versus Unfractionated Heparin in Elderly Patients Undergoing Primary Percutaneous Coronary Intervention: An Analysis of the Randomized ATOLL Trial.
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%, Padjusted= .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.
authors: 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.
authors: Zhenyu
authors: Z
authors: Liu
authors: UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
authors: Johanne
authors: J
authors: Silvain
authors: UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
authors: Mathieu
authors: M
authors: Kerneis
authors: UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
authors: Olivier
authors: O
authors: Barthélémy
authors: UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
authors: Laurent
authors: L
authors: Payot
authors: UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
authors: Rémi
authors: R
authors: Choussat
authors: UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
authors: Pierre
authors: P
authors: Sabouret
authors: Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
authors: Marc
authors: M
authors: Cohen
authors: Department of Emergency Medicine, Pennsylvania Hospital, Philadelphia, PA, USA.
authors: Charles V
authors: CV
authors: Pollack
authors: Emergency Department, Lille University Hospital, Lille, France.
authors: Patrick
authors: P
authors: Goldstein
authors: Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors: Uwe
authors: U
authors: Zeymer
authors: 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
authors: Kurt
authors: K
authors: Huber
authors: ACTION Study Group, Unité de Recherche Clinique, Hôpital Lariboisière (APHP), Paris, France.
authors: Eric
authors: E
authors: Vicaut
authors: UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
authors: Jean-Philippe
authors: JP
authors: Collet
authors: UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France gilles.montalescot@aphp.fr.
authors: Gilles
authors: G
authors: Montalescot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D017984:Enoxaparin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006493:Heparin
keywords: aged; enoxaparin; heparin; myocardial infarction; percutaneous coronary intervention