@article {Armstrong1421, author = {Paul W. Armstrong and Wei-Ching Chang and Lars Wallentin and Patrick Goldstein and Christopher B. Granger and Kris Bogaerts and Thierry Danays and Frans Van de Werf}, editor = {,}, title = {Efficacy and safety of unfractionated heparin versus enoxaparin: a pooled analysis of ASSENT-3 and -3 PLUS data}, volume = {174}, number = {10}, pages = {1421--1426}, year = {2006}, doi = {10.1503/cmaj.051410}, publisher = {CMAJ}, abstract = {Background: The optimal antithrombotic therapy to accompany tenecteplase in cases of acute ST-segment elevation myocardial infarction (STEMI) remains unclear. We undertook a prespecified pooled analysis of data from the ASSENT-3 and ASSENT-3 PLUS trials. Methods: We created a combined database of the 2040 and 818 patients who received enoxaparin in ASSENT-3 and ASSENT-3 PLUS, respectively, and compared them with the 2038 and 821 patients who received unfractionated heparin. Results: The primary efficacy end point, a composite of 30-day mortality, reinfarction or refractory ischemia, was 16.0\% with enoxaparin versus 12.2\% with unfractionated heparin (p \< 0.001); the efficacy plus safety (intracranial hemorrhage [ICH] or major systemic bleeding) end point, 18.0\% versus 15.0\% (p = 0.003). The 1049 patients urgently revascularized had greater benefit from enoxaparin (15.4\% v. 10.1\%, p = 0.013), yet the excess in major systemic bleeding evident with enoxaparin (3.3\% v. 2.4\%, p = 0.01) was largely confined to the 3492 patients without or before revascularization. Although ICH rates in the groups were similar (1.3\% v. 0.9\%, p = 0.26), an excess of ICH occurred among those administered enoxaparin during the ASSENT-3 PLUS trial (6.7\% v. 0.8\%, p = 0.013), especially among women over 75 years of age. Interpretation: These data demonstrated the benefit of enoxaparin used in conjunction with tenecteplase, but raised caution about its prehospital use to treat STEMI in elderly women.}, issn = {0820-3946}, URL = {https://www.cmaj.ca/content/174/10/1421}, eprint = {https://www.cmaj.ca/content/174/10/1421.full.pdf}, journal = {CMAJ} }