LONDON (Reuters Health) – The combination of enoxaparin plus tenecteplase appears to be a safe and effective reperfusion strategy after acute myocardial infarction, Belgian researchers report in the August 25th issue of The Lancet.
Dr. Frans J. Van de Werf from Gasthuisberg University Hospital, in Leuven, and colleagues from The Assessment of the Safety and Efficacy of a New Thrombolytic Regimen study randomly assigned 6095 AMI patients to one of three reperfusion regimens.
Patients received standard reperfusion therapy with a full dose of tenecteplase plus weight-adjusted unfractionated heparin for 48 hours, or one of two experimental regimens: half-dose tenecteplase plus low-dose weight-adjusted unfractionated heparin and a 12-hour infusion of abciximab, or full-dose tenecteplase plus enoxaparin for up to 7 days.
The primary endpoints were a composite efficacy endpoint including 30-day mortality, in-hospital reinfarction and in-hospital refractory ischemia, and a composite safety endpoint that also included in-hospital major bleeding complications.
Results among patients in the two experimental treatments were significantly better for both endpoints compared with standard treatment, Dr. Van de Werf told Reuters Health.
More patients receiving standard therapy, 15.4%, met the efficacy endpoint compared with 11.1% of the patients receiving abciximab (p = 0.0002) and 11.4% of those receiving enoxaparin (p < 0.0001). Seventeen percent of the patients receiving standard therapy met the safety endpoint compared with 14.2% of the abciximab group (p = 0.01416) and 13.7% of the enoxaparin group (p = 0.0037).
There were no striking differences between the two experimental arms, but overall the excess of bleeding complications was significant for abciximab and not statistically significant for enoxaparin, Dr. Van de Werf noted.
"If you take into account efficacy, safety, ease of administration [and] the lack of need for monitoring anticoagulation, it is fair to say that the combination of tenecteplase and enoxaparin is the best treatment," he said.