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Tytuł oryginału: Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction.
Autorzy: Simoons M. L., Krzemińska-Pakuła M., Alonso A., Goodman S. G., Kali A., Loos U., Gosset F., Louer V., Bigonzi F.
Źródło: Eur. Heart J. 2002: 23 (16) s.1282-1290, il., tab., bibliogr. 37 poz.
Sygnatura GBL: 306,213

Hasła klasyfikacyjne GBL:
  • kardiologia

    Typ dokumentu:
  • praca kliniczna
  • praca opublikowana za granicą
  • tytuł obcojęzyczny

    Wskaźnik treści:
  • ludzie
  • dzieci 13-18 r.ż.
  • dorośli 19-44 r.ż.
  • dorośli 45-64 r.ż.
  • dorośli = 65 r.ż.

    Streszczenie angielskie: Aims. To establish whether the addition of enoxaparin (a low-molecular-weight heparin0 to streptokinase therapy improves early and sustained patency and clinical outcome in patients with evolving myocardial infarction. Methods and results. A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30 mg) and subcutaneous injections (1 mgúkg-1 twice daily) of enoxaparin (n = 253), or placebo (n = 243) for 3-8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90 min and 180 min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180 min was observed in 36 p.c., 44 p.c. and 19 p.c. in the enoxaparin group vs 25 p.c., 44 p.c. and 31 p.c. in the placebo group, rspectively (P = 0.004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70 p.c. vs 58 p.c., P = 0ú01). Combined TIMI-2 and -3 flow was also improved (88 p.c. vs 72 p.c., P = 0ú001), as was TIMI frame count (P = 0ú003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13 p.c. vs 21 p.c., P = 0.03). Conclusion. Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5-10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion.

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