A RANDOMIZED TRIAL OF INTRAVENOUS HEPARIN IN CONJUNCTION WITH ANISTREPLASE (ANISOYLATED PLASMINOGEN STREPTOKINASE ACTIVATOR COMPLEX) IN ACUTE MYOCARDIAL-INFARCTION - THE DUKE-UNIVERSITY CLINICAL CARDIOLOGY STUDY (DUCCS) .1.

被引:43
作者
OCONNOR, CM [1 ]
MEESE, R [1 ]
CARNEY, R [1 ]
SMITH, J [1 ]
CONN, E [1 ]
BURKS, J [1 ]
HARTMAN, C [1 ]
ROARK, S [1 ]
SHADOFF, N [1 ]
HEARD, M [1 ]
MITTLER, B [1 ]
COLLINS, G [1 ]
NAVETTA, F [1 ]
LEIMBERGER, J [1 ]
LEE, K [1 ]
CALIFF, RM [1 ]
SANFORD, CF [1 ]
DICK, DM [1 ]
RANDALL, R [1 ]
KUMMERFELD, K [1 ]
MURPHY, G [1 ]
LEBOEUF, R [1 ]
SPENCER, S [1 ]
SMITH, JE [1 ]
MACKRELL, J [1 ]
ANDERSON, GP [1 ]
DUGAN, TM [1 ]
BUETKOFER, JA [1 ]
HEIBEL, RH [1 ]
MCCLELLAN, JR [1 ]
BLAKE, JI [1 ]
HENRY, P [1 ]
CONN, E [1 ]
BERGLUND, RK [1 ]
HUNT, NC [1 ]
WRIGHT, K [1 ]
PARKER, S [1 ]
HOBACK, JW [1 ]
MCWILLIAMS, C [1 ]
BURKS, J [1 ]
CALDER, JR [1 ]
KEATING, EC [1 ]
KIRBY, J [1 ]
HARTMAN, CW [1 ]
ASHBY, CC [1 ]
DICKINSON, WA [1 ]
BARTEL, AG [1 ]
CALL, TD [1 ]
KENERSON, JG [1 ]
ROBBINS, JA [1 ]
机构
[1] DUKE UNIV,MED CTR,DEPT COMMUNITY & FAMILY MED,DIV BIOMETRY,DURHAM,NC 27710
关键词
D O I
10.1016/0735-1097(94)90496-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. We designed a randomized trial to evaluate the effects of heparin administration in conjunction with anistreplase (anisoylated plasminogen streptokinase activator complex [APSAC]) on arterial patency and clinical end points. Background. The role of conjunctive intravenous heparin therapy with APSAC has not been tested despite the recommendations that intravenous heparin should be used. Methods. Four hours after APSAC administration, 250 patients with acute myocardial infarction were randomly assigned to receive 325 mg of either aspirin alone or aspirin and a continuous infusion of heparin (15 IU/kg body weight per h). Clinical ischemic events and bleeding complications were monitored. On hospital day 5, coronary arteriography and left ventriculography were performed. Results. The primary end point of the trial (the combined outcome of death, reinfarction, recurrent ischemia and occlusion of the infarct-related artery) occurred in 42% of the heparin-treated group versus 43% of the group treated without heparin (p = 0.94). A patent infarct-related artery was present in 80% of the patients treated with heparin and in 73% of those treated without heparin (p = 0.26). Left ventricular function, as measured by ejection fraction, was well preserved in both groups (52% vs. 50.5%, respectively, p = 0.29). The overall bleeding rate was higher in patients with (32%) than without (17.2%) heparin (p = 0.006). Conclusions. Weight-adjusted intravenous heparin therapy after APSAC in acute myocardial infarction does not reduce the combined incidence of death, reinfarction, recurrent ischemia and occlusion of the infarct-related artery. Furthermore, withholding intravenous heparin therapy is associated with a 46 % reduction in bleeding complications. Our findings do not support the addition of intravenous heparin after APSAC therapy, as currently recommended, and suggest that a strategy of withholding heparin is simpler and safer and does not place the patient at increased risk for ischemic complications after myocardial infarction.
引用
收藏
页码:11 / 18
页数:8
相关论文
共 53 条
  • [41] FIBRINOLYSIS WITH ACYL-ENZYMES - A NEW APPROACH TO THROMBOLYTIC THERAPY
    SMITH, RAG
    DUPE, RJ
    ENGLISH, PD
    GREEN, J
    [J]. NATURE, 1981, 290 (5806) : 505 - 508
  • [42] A RANDOMIZED COMPARISON OF INTRAVENOUS HEPARIN WITH ORAL ASPIRIN AND DIPYRIDAMOLE 24 HOURS AFTER RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR FOR ACUTE MYOCARDIAL-INFARCTION
    THOMPSON, PL
    AYLWARD, PE
    FEDERMAN, J
    GILES, RW
    HARRIS, PJ
    HODGE, RL
    NELSON, GIC
    THOMSON, A
    TONKIN, AM
    WALSH, WF
    [J]. CIRCULATION, 1991, 83 (05) : 1534 - 1542
  • [43] A RANDOMIZED CONTROLLED TRIAL OF INTRAVENOUS TISSUE PLASMINOGEN-ACTIVATOR AND EARLY INTRAVENOUS HEPARIN IN ACUTE MYOCARDIAL-INFARCTION
    TOPOL, EJ
    GEORGE, BS
    KEREIAKES, DJ
    STUMP, DC
    CANDELA, RJ
    ABBOTTSMITH, CW
    ARONSON, L
    PICKEL, A
    BOSWICK, JM
    LEE, KL
    ELLIS, SG
    CALIFF, RM
    [J]. CIRCULATION, 1989, 79 (02) : 281 - 286
  • [44] WHICH THROMBOLYTIC AGENT SHOULD ONE CHOOSE
    TOPOL, EJ
    [J]. PROGRESS IN CARDIOVASCULAR DISEASES, 1991, 34 (03) : 165 - 178
  • [45] COMPARISON OF HIGH-DOSE WITH LOW-DOSE SUBCUTANEOUS HEPARIN TO PREVENT LEFT-VENTRICULAR MURAL THROMBOSIS IN PATIENTS WITH ACUTE TRANSMURAL ANTERIOR MYOCARDIAL-INFARCTION
    TURPIE, AGG
    ROBINSON, JG
    DOYLE, DJ
    MULJI, AS
    MISHKEL, GJ
    SEALEY, BJ
    CAIRNS, JA
    SKINGLEY, L
    HIRSH, J
    GENT, M
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (06) : 352 - 357
  • [46] VANDEWERF F, 1989, LANCET, V1, P1367
  • [47] VONESSEN R, 1991, EUR HEART J SUPPL, V12, P30
  • [48] Wang-Gillam A., 2016, LANCET, V387, P545
  • [49] 1992, LANCET, V339, P753
  • [50] 1990, LANCET, V335, P427