Abstract 3295: Enoxaparin is Superior to Unfractionated Heparin in Patients with STEMI Undergoing Fibrinolysis Regardless of the Choice of Lytic-type: ExTRACT-TIMI 25 Analysis
Fibrinolytic therapy (FT) is the leading reperfusion strategy for STEMI. In ExTRACT-TIMI 25, adjuvant treatment with enoxaparin (ENOX) was superior to unfractionated heparin (UFH) in pts with STEMI receiving FT. We examined whether the benefit of ENOX was seen across all lytics. We analyzed 30-day outcomes of the 20479 pts in ExTRACT-TIMI 25. Pts with STEMI to undergo FT were randomized to UFH or ENOX. Randomization was stratified by fibrin-specific lytic vs SK. In the trial, TNK was used in 3986 (20%), t-PA in 11175 (55%), r-PA in 1122 (5%) and SK in 4139 (20%). ENOX was associated with lower rates of death/nonfatal MI (NFMI) compared to UFH regardless of the lytic agent at 30 days. A similar pattern of ENOX was seen for death/NFMI/urgent revasc and death/NFMI/major bleed (net clinical benefit). ENOX leads to significant 16% RRR (2–28) in death/NFMI/urgent revasc in pts treated with SK, including RRRs of 29% (1–49) in MI and of 17% (8–43) in myocardial ischemia. ENOX is associated with improved outcomes compared to UFH across all fibrinolytic agents used in pts with STEMI undergoing FT.