This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Frostfeldt, G. Articles by Wallentin, L. Search for Related Content PubMed PubMed Citation Articles by Frostfeldt, G. Articles by Wallentin, L.

CLINICAL STUDIES

Low molecular weight heparin (dalteparin) as adjuvant treatment to thrombolysis in acute myocardial infarction—a pilot study: Biochemical Markers in Acute Coronary Syndromes (BIOMACS II)

Gunnar Frostfeldt, MD^a, Greger Ahlberg, MD^*, Gunnar Gustafsson, MD, Gunnar Helmius, MD, PhD, Bertil Lindahl, MD, PhD^a, Anders Nygren, MD, PhD, Agneta Siegbahn, MD, PhD, Eva Swahn, MD, PhD^||, Per Venge, MD, PhD and Lars Wallentin, MD, PhD^*

^a Department of Cardiology, Cardiothoracic Centre, University Hospital, Uppsala, Sweden
^* Department of Medicine, Falu County Hospital, Falun, Sweden
Department of Medicine, Gävle County Hospital, Gävle, Sweden
Department of Diagnostic Radiology, University Hospital, Uppsala, Sweden
Department of Clinical Chemistry, University Hospital, Uppsala, Sweden
^|| Department of Cardiology, University Hospital, Linköping, Sweden

Manuscript received July 6, 1998; revised manuscript received October 9, 1998, accepted November 6, 1998.

Reprint requests and correspondence: Dr. Gunnar Frostfeldt, Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden
Gunnar.Frostfeldt{at}medicin.uu.se

OBJECTIVES

This randomized, double blind, placebo-controlled pilot trial evaluated the effect of dalteparin as an adjuvant to thrombolysis in patients with acute myocardial infarction regarding early reperfusion, recurrent ischemia and patency at 24 h.

BACKGROUND

Low-molecular-weight heparin, given subcutaneously twice daily without monitoring, might be an attractive alternative to conventional intravenous heparin in the treatment of acute myocardial infarction.

METHODS

In 101 patients dalteparin/placebo 100 IU/kg was given just before streptokinase and a second injection 120 IU/kg after 12 h. Monitoring with continuous vector-ECG was done to obtain signs of early reperfusion and later ischemic episodes. Blood samples for myoglobin were obtained at start and after 90 min to evaluate signs of reperfusion. Coronary angiography was performed after 20–28 h to evaluate TIMI-flow in the infarct-related artery.

RESULTS

Dalteparin added to streptokinase tended to provide a higher rate of TIMI grade 3 flow in infarct-related artery compared to placebo, 68% versus 51% (p = 0.10). Dalteparin had no effects on noninvasive signs of early reperfusion. In patients with signs of early reperfusion, there seemed to be a higher rate of TIMI grade 3 flow, 74% versus 46% (myoglobin) (p = 0.04) and 73% versus 52% (vector-ECG) (p = 0.11). Ischemic episodes 6–24 h. after start of treatment were fewer in the dalteparin group, 16% versus 38% (p = 0.04).

CONCLUSIONS

When dalteparin was added as an adjuvant to streptokinase and aspirin, there were tendencies for less ECG monitoring evidence of recurrent ischemia and better patency at 24 h, warranting further study.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   GUSTO = Global Utilization of Streptokinase and t-PA for Occluded Arteries   Lmw-heparin = low-molecular-weight heparin   PTCA = percutaneous coronary angioplasty   STVM = ST vector magnitude   TIMI = Thrombolysis In Myocardial Infarction Trial

This article has been cited by other articles:

				S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 708S - 775S. [Abstract] [Full Text] [PDF]

				J. W. Eikelboom, D. J. Quinlan, S. R. Mehta, A. G. Turpie, I. B. Menown, and S. Yusuf Unfractionated and Low-Molecular-Weight Heparin as Adjuncts to Thrombolysis in Aspirin-Treated Patients With ST-Elevation Acute Myocardial Infarction: A Meta-Analysis of the Randomized Trials Circulation, December 20, 2005; 112(25): 3855 - 3867. [Abstract] [Full Text] [PDF]

				J. S Kalus and L. R Moser Evolving Role of Low-Molecular-Weight Heparins in ST-Elevation Myocardial Infarction Ann. Pharmacother., March 1, 2005; 39(3): 481 - 491. [Abstract] [Full Text] [PDF]

				V. Menon, R. A. Harrington, J. S. Hochman, C. P. Cannon, S. D. Goodman, R. G. Wilcox, H. J. Schunemann, and E. M. Ohman Thrombolysis and Adjunctive Therapy in Acute Myocardial Infarction: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 549S - 575S. [Abstract] [Full Text] [PDF]

				L. Wallentin, P. Goldstein, P.W. Armstrong, C.B. Granger, A.A.J. Adgey, H.R. Arntz, K. Bogaerts, T. Danays, B. Lindahl, M. Makijarvi, et al. Efficacy and Safety of Tenecteplase in Combination With the Low-Molecular-Weight Heparin Enoxaparin or Unfractionated Heparin in the Prehospital Setting: The Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 PLUS Randomized Trial in Acute Myocardial Infarction Circulation, July 15, 2003; 108(2): 135 - 142. [Abstract] [Full Text] [PDF]

				L. Wallentin, L. Bergstrand, M. Dellborg, C. Fellenius, C. B Granger, B. Lindahl, L.-E. Lins, T. Nilsson, K. Pehrsson, A. Siegbahn, et al. Low molecular weight heparin (dalteparin) compared to unfractionated heparin as an adjunct to rt-PA (alteplase) for improvement of coronary artery patency in acute myocardial infarction--the ASSENT Plus study Eur. Heart J., May 2, 2003; 24(10): 897 - 908. [Abstract] [Full Text] [PDF]

				M. Cohen The role of low-molecular-weight heparin in the management of acute coronary syndromes J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 55S - 61S. [Abstract] [Full Text] [PDF]

				G. C. Wong, R. P. Giugliano, and E. M. Antman Use of Low-Molecular-Weight Heparins in the Management of Acute Coronary Artery Syndromes and Percutaneous Coronary Intervention JAMA, January 15, 2003; 289(3): 331 - 342. [Abstract] [Full Text] [PDF]

				The Task Force on the Management of Acute Myocardi, F. Van de Werf, D. Ardissino, A. Betriu, D. V. Cokkinos, E. Falk, K. A.A. Fox, D. Julian, M. Lengyel, F.-J. Neumann, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation Eur. Heart J., January 1, 2003; 24(1): 28 - 66. [Full Text] [PDF]

				H. D. White Further evidence that antithrombotic therapy is beneficial with streptokinase: improved early ST resolution and late patency with enoxaparin Eur. Heart J., August 2, 2002; 23(16): 1233 - 1237. [PDF]

				M.L. Simoons, M. Krzeminska-Pakula, A. Alonso, S.G. Goodman, A. Kali, U. Loos, F. Gosset, V. Louer, and F. Bigonzi Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study Eur. Heart J., August 2, 2002; 23(16): 1282 - 1290. [Abstract] [PDF]

				F.J. Van de Werf, E.M. Antman, and M.L. Simoons Managing ST elevation myocardial infarction Eur. Heart J. Suppl., May 1, 2002; 4(suppl_E): E15 - E23. [Abstract] [PDF]

				C.P. Cannon Enoxaparin in ST elevation MI--a bright future Eur. Heart J., April 2, 2002; 23(8): 591 - 592. [Full Text] [PDF]

				S.H. Baird, I.B.A. Menown, S.J. Mcbride, T.G. Trouton, and C. Wilson Randomized comparison of enoxaparin with unfractionated heparin following fibrinolytic therapy for acute myocardial infarction Eur. Heart J., April 2, 2002; 23(8): 627 - 632. [Abstract] [Full Text] [PDF]

				A. M. Ross, P. Molhoek, C. Lundergan, M. Knudtson, Y. Draoui, L. Regalado, V. Le Louer, F. Bigonzi, W. Schwartz, E. de Jong, et al. Randomized Comparison of Enoxaparin, a Low-Molecular-Weight Heparin, With Unfractionated Heparin Adjunctive to Recombinant Tissue Plasminogen Activator Thrombolysis and Aspirin: Second Trial of Heparin and Aspirin Reperfusion Therapy (HART II) Circulation, August 7, 2001; 104(6): 648 - 652. [Abstract] [Full Text] [PDF]

				J. Hirsh, S. S. Anand, J. L. Halperin, and V. Fuster Guide to Anticoagulant Therapy: Heparin : A Statement for Healthcare Professionals From the American Heart Association Arterioscler Thromb Vasc Biol, July 1, 2001; 21 (7): e9 - e9. [Full Text] [PDF]

				P. W. Armstrong and D. Collen Fibrinolysis for Acute Myocardial Infarction : Current Status and New Horizons for Pharmacological Reperfusion, Part 2 Circulation, June 19, 2001; 103(24): 2987 - 2992. [Full Text] [PDF]

				J. Hirsh, S. S. Anand, J. L. Halperin, and V. Fuster Guide to Anticoagulant Therapy: Heparin : A Statement for Healthcare Professionals From the American Heart Association Circulation, June 19, 2001; 103(24): 2994 - 3018. [Full Text] [PDF]

				J. Lopez-Sendon Coronary reperfusion in the clinical setting: antithrombotic support to thrombolysis in the coronary care unit Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C55 - C61. [Abstract] [PDF]

				G. G Nenci and A. Minciotti Low molecular weight heparins for arterial thrombosis Vascular Medicine, November 1, 2000; 5(4): 251 - 258. [Abstract] [PDF]

				M.E Bertrand, M.L Simoons, K.A.A Fox, L.C Wallentin, C.W Hamm, E McFadden, P.J de Feyter, G Specchia, and W Ruzyllo Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology: Recommendations of the Task Force of the European Society of Cardiology Eur. Heart J., September 1, 2000; 21(17): 1406 - 1432. [PDF]