Medical management |
EXTRACT-TIMI 25 (33) | 20 506 patients with STEMI receiving fibrinolysis | IV then SC enoxaparin up to 8 d or discharge v. IV UFH for 48 h | Death or MI at 30 d: 9.9% v. 12.0% (RR 0.83, 95% CI 0.77–0.90) | Major bleeding at 30 d: 2.1% v. 1.4% (RR 1.53, 95% CI 1.23– 1.89) |
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OASIS-5 (34) | 20 078 patients with non–ST elevation ACS | SC fondaparinux up to 8 d or discharge v. SC enoxaparin for 2–8 d | Death, MI or refractory ischemia at 9 d: 5.7% v. 5.8% (HR 1.01, 95% CI 0.90–1.13) | Major bleeding at 9 d: 2.2% v. 4.1% (HR 0.52, 95% CI 0.44–0.61) |
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OASIS-6 (35) | 12 092 patients with STEMI, 47% of whom were not scheduled for primary PCI | SC fondaparinux up to 8 d v. placebo | Death or MI at 30 d: 11.2% v. 14.0% (HR 0.79, 95% CI 0.68–0.92) | Major bleeding at 30 d: 1.4% v. 2.0% (HR 0.68, 95% CI 0.45–1.02) |
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SC fondaparinux up to 8 d v. IV UFH for 48 h | 11.5% v. 13.8% (HR 0.82, 95% CI 0.66–1.02) | 2.2% v. 3.2% (HR 0.66, 95% CI 0.41– 1.07) |
Invasive management |
SYNERGY (36) | 10 027 patients with non–ST elevation ACS managed invasively | SC enoxaparin v. IV UFH | Death or MI at 30 d: 14.0% v. 14.5% (HR 0.96, 95% CI 0.86–1.06) | Non-CABG related major bleeding at 30 d: 2.4% v. 1.8% (HR not available, p = 0.03) |
Angiography in 92% of patients Median time from randomization to PCI: 23 h Dose adjusted if CrCl < 30 mL/min
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OASIS-6 (35) | 12 092 patients with STEMI, 53% of whom were scheduled for primary PCI | IV then SC fondaparinux for up to 8 d v. IV UFH titrated in the catheterization laboratory | 6.1% v. 5.1% (HR 1.20, 95% CI 0.91–1.57) | 2.2% v. 1.7% (HR 1.30, 95% CI 0.81– 2.08) |
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ACUITY (37) | 13 819 patients with non–ST elevation ACS managed invasively | IV bivalirudin v. IV bivalirudin + glycoprotein IIb/IIIa inhibitors v. IV UFH/SC enoxaparin + glycoprotein IIb/IIIa inhibitors | Death, MI or revascularization at 30 d: Bivalirudin v. UFH/enoxaparin + glycoprotein IIb/IIIa inhibitors: 7.8% v. 7.3% (RR 1.08, 95% CI 0.93– 1.24) Bivalirudin + glycoprotein IIb/IIIa inhibitors v. UFH/enoxaparin + glycoprotein IIb/IIIa inhibitors: 7.7% v. 7.3% (RR 1.07, 95% CI 0.92– 1.23) | Non–CABG related major bleeding at 30 d: Bivalirudin v. UFH/enoxaparin + glycoprotein IIb/IIIa inhibitors: 3.0% v. 5.7% (RR 0.53, 95% CI 0.43–0.65) Bivalirudin + glycoprotein IIb/IIIa inhibitors v. UFH/enoxaparin + glycoprotein IIb/IIIa inhibitors: 5.3% v. 5.7% (RR 0.93, 95% CI 0.78–1.10) |
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HORIZONS-AMI (38) | 3602 patients with STEMI managed by PCI | Bivalirudin v. IV UFH + glycoprotein IIb/IIIa inhibitors | Death, MI, stroke or target-vessel revascularization at 30 d: 5.4% v. 5.5% (RR 1.00, 95% CI 0.75–1.32) | Non–CABG related major bleeding at 30 d: 4.9% v. 8.3% (RR 0.59, 95% CI 0.45– 0.76) |
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