Antithrombotic therapy during percutaneous coronary intervention for ST-segment elevation myocardial infarction has evolved substantially over the past 15 years. With the results of the ATOLL trial, enoxaparin should now be considered a therapeutic alternative to unfractionated heparin in the treatment of such patients. Comparative studies of enoxaparin and bivalirudin, using standardized bleeding definitions, are warranted.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Ryan, T. J. et al. 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. 28, 1328–1428 (1996).
Montalescot, G. et al. Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. Lancet 378, 693–703 (2011).
Antman, E. M. et al. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial. Circulation 100, 1593–1601 (1999).
Cohen, M. et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. N. Engl. J. Med. 337, 447–452 (1997).
Montalescot, G. et al. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N. Engl. J. Med. 355, 1006–1017 (2006).
Hamon, M. et al. Choice of arterial access site and outcomes in patients with acute coronary syndromes managed with an early invasive strategy: the ACUITY trial. EuroIntervention 5, 115–120 (2009).
Rao, S. V. et al. A comparison of the clinical impact of bleeding measured by two different classifications among patients with acute coronary syndromes. J. Am. Coll. Cardiol. 47, 809–816 (2006).
Mehran, R. et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123, 2736–2747 (2011).
Kushner, F. G. et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 54, 2205–2241 (2009).
Kadakia, M. B. et al. Use of anticoagulant agents and risk of bleeding among patients admitted with myocardial infarction: a report from the NCDR ACTION Registry—GWTG (National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry—Get With the Guidelines). JACC Cardiovasc. Interv. 3, 1166–1177 (2010).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
R. Mehran has acted as a consultant for Abbott, AstraZeneca, Ortho-McNeil, and Regado Biosciences, and has received grants/research support from Bristol-Myers Squibb and Sanofi Aventis. U. Baber declares no competing interests.
Rights and permissions
About this article
Cite this article
Baber, U., Mehran, R. Antithrombotics in ACS—moving beyond unfractionated heparin. Nat Rev Cardiol 8, 613–614 (2011). https://doi.org/10.1038/nrcardio.2011.153
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrcardio.2011.153
