Overview of randomized trials of intravenous heparin in patients with acute myocardial infarction treated with thrombolytic therapy

The American Journal of Cardiology
K W MahaffeyR Califf

Abstract

Intravenous heparin is routinely given after thrombolytic therapy for patients with acute myocardial infarction in the United States and in some, but by no means all, other countries. Several trials have documented improved infarct-artery patency in patients treated with heparin; however, none was large enough individually to assess the effect of heparin on clinical outcomes. We performed a systematic overview of the 6 randomized controlled trials (1,735 patients) to summarize the available data concerning the risks and benefits of intravenous heparin versus no heparin after thrombolytic therapy. Mortality before hospital discharge was 5.1% for patients allocated to intravenous heparin compared with 5.6% for controls (relative risk reduction of 9%, odds ratio 0.91, 95% confidence interval 0.59 to 1.39). Similar rates of recurrent ischemia and reinfarction were observed among those allocated to heparin therapy or control. The rates of total stroke, intracranial hemorrhage, and severe bleeding were similar in patients allocated to heparin; however, the risk of any severity of bleeding was significantly higher (22.7% vs 16.2%; odds ratio 1.55, 95% confidence interval 1.21 to 1.98). There was no significant difference in the observ...Continue Reading

References

Nov 1, 1984·American Heart Journal·R J GoldbergJ E Dalen
Sep 2, 1993·The New England Journal of Medicine·UNKNOWN GUSTO investigators

❮ Previous
Next ❯

Citations

Jan 23, 1999·BMJ : British Medical Journal·S M Hardman, M R Cowie
Jan 22, 2010·Journal of Thrombosis and Thrombolysis·S Michael GharacholouJohn H Alexander
May 9, 2012·Journal of Thrombosis and Thrombolysis·S Michael GharacholouAmish N Raval
Mar 20, 1997·The New England Journal of Medicine·R CollinsP Sleight
Mar 16, 2006·The New England Journal of Medicine·Raymond J Gibbons, Valentin Fuster
Sep 1, 2004·Pharmacotherapy·Thomas L RihnUNKNOWN Heparin Consensus Group
Jun 3, 2004·Best Practice & Research. Clinical Haematology·Richard L Mueller
Apr 22, 2011·Journal of Pharmacy Practice·Paul P Dobesh, Toby C Trujillo
Apr 12, 2003·Stroke; a Journal of Cerebral Circulation·Brett CucchiaraScott E Kasner
Dec 1, 2005·Expert Review of Pharmacoeconomics & Outcomes Research·Sean M Donahoe, Marc S Sabatine
Feb 27, 2009·Current Opinion in Pediatrics·Leslie Raffini
Oct 20, 1998·Australian and New Zealand Journal of Medicine·C B Granger
Jul 14, 2001·Arteriosclerosis, Thrombosis, and Vascular Biology·J HirshUNKNOWN American Heart Association
Oct 6, 1999·British Journal of Clinical Pharmacology·S Maxwell
Dec 12, 2001·Blood Reviews·V J Marder

❮ Previous
Next ❯

Related Concepts

Related Feeds

Cardiovascular Diseases: Risk Factors

Cardiovascular disease is a significant health concern. Risk factors include hypertension, obesity, dyslipidemia and smoking. Women who are postmenopausal are at an increased risk of heart disease. Here is the latest research for risk factors of cardiovascular disease.