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(Circulation. 2001;104:648.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Randomized Comparison of Enoxaparin, a Low-Molecular-Weight Heparin, With Unfractionated Heparin Adjunctive to Recombinant Tissue Plasminogen Activator Thrombolysis and Aspirin

Second Trial of Heparin and Aspirin Reperfusion Therapy (HART II)

Allan M. Ross, MD; Peter Molhoek, MD; Conor Lundergan, MD; Merrill Knudtson, MD; Yasmine Draoui, MS; Lorna Regalado, RN; Veronique Le Louer, MS; Frederique Bigonzi, MD; Whitney Schwartz, BA; Egbert de Jong, MD; Karin Coyne, PhD

From the Cardiovascular Research Institute, Institute of Medicine, George Washington University, Washington, DC (A.M.R., C.L., Y.D., L.R., K.C.); Medisch Spectrum Twente, Enschede, The Netherlands (P.M.); the University of Calgary, Alberta, Canada (M.K.); and Aventis Pharma, Paris, France, and Bridgewater, NJ (V.L.L., F.B., W.S., E.d.J.).

Correspondence to Allan M. Ross, MD, George Washington University School of Medicine, Cardiology Division, 2150 Pennsylvania Ave NW, Washington, DC 20037. E-mail allanmross{at}aol.com

Background—— Adjunctive unfractionated heparin (UFH) during thrombolytic therapy for acute myocardial infarction (AMI) promotes the speed and magnitude of coronary artery recanalization and reduces reocclusion. Low-molecular-weight heparins offer practical and potential pharmacological advantages over UFH in multiple applications but have not been systematically studied as adjuncts to fibrinolysis in AMI.

Methods and Results—— Four hundred patients undergoing reperfusion therapy with an accelerated recombinant tissue plasminogen activator regimen and aspirin for AMI were randomly assigned to receive adjunctive therapy for at least 3 days with either enoxaparin or UFH. The study was designed to show noninferiority of enoxaparin versus UFH with regard to infarct-related artery patency. Ninety minutes after starting therapy, patency rates (thrombolysis in myocardial infarction [TIMI] flow grade 2 or 3) were 80.1% and 75.1% in the enoxaparin and UFH groups, respectively. Reocclusion at 5 to 7 days from TIMI grade 2 or 3 to TIMI 0 or 1 flow and TIMI grade 3 to TIMI 0 or 1 flow, respectively, occurred in 5.9% and 3.1% of the enoxaparin group versus 9.8% and 9.1% in the UFH group. Adverse events occurred with similar frequency in both treatment groups.

Conclusions—— Enoxaparin was at least as effective as UFH as an adjunct to thrombolysis, with a trend toward higher recanalization rates and less reocclusion at 5 to 7 days.

Key Words: myocardial infarction • thrombolysis • reperfusion • heparin • trials

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