Читать книгу Interventional Cardiology - Группа авторов - Страница 326

The ATOLL trial randomly assigned 910 patients undergoing primary PCI for STEMI to either 0.5 mg/kg enoxaparin IV or unfractionated heparin (UFH), and looked at a primary endpoint at 30 days of death, complication of MI, procedure failure or haemorrhage [91]. It revealed a relative risk of 0.83 (95% CI 0.68–1.01; p = 0.06) for the primary endpoint for enoxaparin compared to UFH. A subsequent meta‐analysis [92], looked at 23 studies (observational and randomized) comparing enoxaparin vs UFH, including 10,243 (33.1%) patients presenting with STEMI. In those patients who underwent primary PCI, a particularly significant reduction in death was noted with enoxaparin (RR 0.52; 95% CI 0.42–0.64; P<0.0001), which was also associated with a reduction in major bleeding (RR 0.73; 95% CI 0.56–0.93; P = 0.01).

On the basis of these findings, enoxaparin has a class IIa recommendation in the ESC STEMI guidelines [3]. A specific recommendation is not made in the AHA guidelines [4].