Skip to main content
SpringerLink
Log in

Use of Unfractionated Heparin and a Low-Molecular-Weight Heparin following Thrombolytic Therapy for Acute ST-Segment Elevation Myocardial Infarction

  • Original Research Article
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Abstract

Background: Acute myocardial infarction (AMI) is one of the most serious cardiovascular diseases, with acute ST-segment elevation myocardial infarction (STEMI) showing a higher mortality rate than non-ST-segment elevation myocardial infarction (NSTEMI). There is evidence that low-molecular-weight heparin (LMWH) shows greater efficacy than unfractionated heparin (UFH). This open-label, single-centre, randomised study was conducted to compare the efficacy and safety of parnaparin sodium, a LMWH, with UFH in patients with STEMI.

Patients and methods: Patients with STEMI were randomised to receive either parnaparin sodium (4250IU aXa subcutaneously every 12 hours for 7 days, initiated 12 hours after thrombolysis) or UFH (100 U/kg intravenous bolus, initiated 12 hours after thrombolytic therapy, followed by 1000 U/hour as a continuous infusion for 3 days, then 7500U subcutaneously every 12 hours for 4 days). Patients were followed up for 45 days (≥14 days in hospital).

Results: In total, 186 patients were randomised to receive parnaparin sodium (n = 96) or UFH (n = 90). A significantly greater reduction in the composite primary endpoint (sum of all deaths, first occurrence of recurrent MI, and first occurrence of emergency revascularisation) was seen with parnaparin sodium compared with UFH at day 45 (27.08% vs 42.22%; p = 0.03). A lower incidence of composite endpoint was seen as early as day 2 with parnaparin sodium, but this did not reach significance versus UFH. The rate of individual endpoint events (death, first occurrence of non-fatal recurrent MI and first occurrence of emergency revascularisation) was lower in the parnaparin sodium group than the UFH group at 2, 7, 14 and 45 days, but the differences were not statistically significant. At day 7, the incidences of any bleeding and heparin-induced thrombocytopenia were also lower in the parnaparin sodium group compared with the UFH group (3.13% vs 10.0%; p = 0.06 and 0% vs 3.33%; p = 0.07, respectively).

Conclusion: The results of this study indicate that parnaparin sodium is more effective than UFH in reducing composite cardiac events in patients with STEMI following thrombolytic therapy. There was also a lower incidence of bleeding and heparin-induced thrombocytopenia with parnaparin sodium than with UFH. In view of these findings, parnaparin sodium represents an effective, convenient and well tolerated alternative to UFH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Table IV

Similar content being viewed by others

References

  1. Gao YQ, Li ZL, Ding MX, et al. Relation of the ST-segment elevation pattern in acute phase of anterior wall acute myocardial infarction to short-term prognosis. Di Yi Jun Yi Da Xue Xue Bao 2002; 22(2): 156–8

    PubMed  CAS  Google Scholar 

  2. Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 Investigators. Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction. Lancet 2001; 358(9282): 605–13

    Article  Google Scholar 

  3. Antman EM, Louwerenburg HW, Baars HF, et al. Enoxaparin as adjunctive antithrombin therapy for ST-elevation myocardial infarction: results of the ENTIRE-Thrombolysis in Myocardial Infarction (TIMI) 23 Trial. Circulation 2002; 105(14): 1642–9

    Article  PubMed  CAS  Google Scholar 

  4. Baird SH, Menown IB, McBride SJ, et al. Randomized comparison of enoxaparin with unfractionated heparin following fibrinolytic therapy for acute myocardial infarction. Eur Heart J 2002; 23(8): 627–32

    Article  PubMed  CAS  Google Scholar 

  5. Cohen M, Antman EM, Gurfinkel E, et al. Impact of enoxaparin low molecular weight heparin in patients with Q-wave myocardial infarction. Am J Cardiol 2000; 86(5): 553–6, A9

    Article  PubMed  CAS  Google Scholar 

  6. Cohen M, Gensini GF, Maritz F, et al. The safety and efficacy of subcutaneous enoxaparin versus intravenous unfractionated heparin and tirofiban versus placebo in the treatment of acute ST-segment elevation myocardial infarction patients ineligible for reperfusion (TETAMI): a randomized trial. J Am Coll Cardiol 2003; 42(8): 1348–56

    Article  PubMed  CAS  Google Scholar 

  7. Theroux P, Welsh RC. Meta-analysis of randomized trials comparing enoxaparin versus unfractionated heparin as adjunctive therapy to fibrinolysis in ST-elevation acute myocardial infarction. Am J Cardiol 2003; 91(7): 860–4

    Article  PubMed  CAS  Google Scholar 

  8. Wallentin L, Goldstein P, Armstrong PW, et al. Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 PLUS randomized trial in acute myocardial infarction. Circulation 2003; 108(2): 135–42

    Article  PubMed  CAS  Google Scholar 

  9. Arici M, Altun B, Dinier O, et al. Haemodialysis hypotension and nitric oxide production: comparison of heparin with parnaparin. Blood Purif 2002; 20(2): 145–9

    Article  PubMed  CAS  Google Scholar 

  10. Pietrelli F, Renzoni T, Cicoli C. Thromboembolic disease: prevention with low-molecular weight heparin in general surgery. Preliminary results [in Italian]. Minerva Chir 1994; 49(6): 585–9

    PubMed  CAS  Google Scholar 

  11. Gioe FP, Arcara M, Scaffidi Abbate F, et al. Low molecular weight heparin (parnaparin) versus calcium heparin in the prevention of thromboembolic disease in general surgery [in Italian]. Minerva Chir 1994; 49(6): 581–4

    PubMed  CAS  Google Scholar 

  12. Verardi S, Casciani CU, Nicora E, et al. A multicentre study on LMW-heparin effectiveness in preventing postsurgical thrombosis. Int Angiol 1988; 7(3 Suppl.): 19–24

    PubMed  CAS  Google Scholar 

  13. Prime Care Study Investigators Group. Comparative efficacy of once daily parnaparin and unfractionated heparin in unstable angina pectoris: PRIME CARE study. Indian Heart J 2005; 57(6): 648–54

    Google Scholar 

  14. Melandri G, Branzi A, Semprini F, et al. Effects of two dosages of subcutaneous low molecular weight heparin (Parnaparin) and of unfractionated heparin on fibrin formation and lipolysis in acute myocardial infarction. Thromb Res 1992; 66(2–3): 141–50

    Article  PubMed  CAS  Google Scholar 

  15. Zhang Y, Wang XK, Yang CM, et al. Use of unfractionated heparin and a low-molecular-weight heparin following thrombolytic therapy for acute ST-segment elevation myocardial infarction [in Chinese]. Di Yi Jun Yi Da Xue Xue Bao 2004; 24(1): 81–4

    PubMed  Google Scholar 

  16. Cardiovascular Branch of Chinese Medical Association; Editorial Board of Chinese Journal of Cardiology; Editorial Board of Chinese Circulation Journal. Guidelines for the diagnosis and management of Chinese patients with acute myocardial infarction. Chin J Cardiol 2001; 29: 710-25

    Google Scholar 

  17. Shao Y, Zhang CG, Sun CJ, et al. Early diagnosis and treatment of intracranial venous thrombosis [in Chinese]. Di Yi Jun Yi Da Xue Xue Bao 2003; 23(2): 184–6

    PubMed  Google Scholar 

  18. Ryan TJ, Antman EM, Brooks NH, et al. 1999 update: ACC/ AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1999; 34(3): 890–911

    Article  PubMed  CAS  Google Scholar 

  19. Fuster V, Badimon L, Badimon JJ, et al. The pathogenesis of coronary artery disease and the acute coronary syndromes (1). N Engl J Med 1992; 326(4): 242–50

    Article  PubMed  CAS  Google Scholar 

  20. Weitz JI. Low-molecular-weight heparins. N Engl J Med 1997; 337(10): 688–98

    Article  PubMed  CAS  Google Scholar 

  21. Liu ZQ, Tang B, Meng SD, et al. Clinical study of hemofiltration in the treatment of delayed graft function. J First Mil Med Univ 2001; 21(9): 691–2

    Google Scholar 

  22. Liu ZQ, Wang L. Comparison of anticoagulation efficacy and clinical safety between imported and domestically manufactured low-molecular-weight heparin during hemodialysis. Di Yi Jun Yi Da Xue Xue Bao 2002; 22(10): 942–3

    PubMed  Google Scholar 

  23. Fareed J, Hoppensteadt DA. Pharmacology of the low-molecular-weight heparins. Semin Thromb Hemost 1996; 22Suppl. 2: 13–8

    PubMed  Google Scholar 

  24. Carter CJ, Kelton JG, Hirsh J, et al. The relationship between the hemorrhagic and antithrombotic properties of low molecular weight heparin in rabbits. Blood 1982; 59(6): 1239–45

    PubMed  CAS  Google Scholar 

  25. Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med 1995; 332(20): 1330–5

    Article  PubMed  CAS  Google Scholar 

  26. Hirsh J, Raschke R, Warkentin TE, et al. Heparin: mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest 1995; 108(4 Suppl.): 258S–75S

    Article  PubMed  CAS  Google Scholar 

  27. Ferguson JJ. Low molecular weight heparins and glycoprotein IIb/IIIa antagonists. J Interv Cardiol 2002; 15(2): 147–54

    Article  PubMed  Google Scholar 

  28. Frampton JE, Faulds D. Parnaparin: a review of its pharmacology, and clinical application in the prevention and treatment of thromboembolic and other vascular disorders. Drugs 1994; 47(4): 652–76

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by scientific funding from the Chongqing government. The authors have no potential conflicts of interest that are directly relevant to the contents of this manuscript.

Author information

Authors and Affiliations

  1. Cardiovascular Department, Daping Hospital, Third Military Medical University, Chongqing, 400042, China

    Xu-Kai Wang, Ye Zhang, Cheng-Ming Yang, Yan Wang & Guang-Yao Liu

Authors
  1. Xu-Kai Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ye Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheng-Ming Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guang-Yao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xu-Kai Wang.

Additional information

An earlier version of this article was published in China [Di Yi Jun Yi Da Xue Xue Bao 2004 Jan; 24 (1): 81–4]

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, XK., Zhang, Y., Yang, CM. et al. Use of Unfractionated Heparin and a Low-Molecular-Weight Heparin following Thrombolytic Therapy for Acute ST-Segment Elevation Myocardial Infarction. Clin. Drug Investig. 26, 341–349 (2006). https://doi.org/10.2165/00044011-200626060-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00044011-200626060-00005

Keywords

Search

Navigation