Efficacy and Safety of Enoxaparin Versus Unfractionated Heparin in Patients With ST-Segment Elevation Myocardial Infarction Also Treated With Clopidogrel
Marc S. Sabatine, MD, MPH, FACC*,1,
David A. Morrow, MD, MPH, FACC*,2,
Anthony Dalby, MD ,
Mathias Pfisterer, MD ,
Tibor Duris, MD ,
Jose Lopez-Sendon, MD, FACC||,3,
Sabina A. Murphy, MPH*,
Runlin Gao, MD, FACC¶,
Elliott M. Antman, MD, FACC*,4,*,
Eugene Braunwald, MD, MACC*,4 for the ExTRACT-TIMI 25 Investigators
* Thrombolysis In Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women’s Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts
South African Cardiology Clinical Trials Group, Milpark Hospital, Johannesburg, South Africa
Kantonsspital, Basel, Switzerland
FNsP, Nove Zamky, Slovakia
|| Hospital Universitario La Paz, Madrid, Spain
¶ Fu Wai Hospital, Beijing, China.
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Figure 1 Proportion of Patients Receiving Clopidogrel in Different Geographic Regions
Regions are based on the United Nations Statistics Geographic Region Codes. North America and Western and Northern Europe includes Austria, Belgium, Canada, Estonia, Finland, France, Germany, Ireland, Latvia, Lithuania, the Netherlands, Norway, Sweden, Switzerland, United Kingdom, and the U.S. Eastern and Southern Europe includes Belarus, Bulgaria, Croatia, Greece, Hungary, Italy, Poland, Portugal, Romania, Russia, Slovakia, Spain, and Ukraine. Latin America includes Argentina, Brazil, Chile, Mexico, and Uruguay. Middle East and Africa includes Israel, Jordan, Lebanon, South Africa, and Turkey. Asia and Australasia includes Australia, China, Hong Kong, India, Republic of Korea, Malaysia, New Zealand, Singapore, and Thailand. p < 0.001 for global chi-square as well as for all pairwise comparisons except for the rates in Latin America versus the Middle East and Africa.
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Figure 2 Proportion of Patients Receiving Clopidogrel as a Function of Date of Enrollment
The first quarter of 2003 also includes a small number of patients (n = 42) enrolled in the last quarter of 2002 (when the trial started enrollment), and the third quarter of 2005 also includes a small number of patients (n = 7) enrolled in the fourth quarter of 2005 (when the trial completed enrollment). CLARITY-TIMI 28 = Clopidogrel as Adjunctive Reperfusion Therapy–Thrombolysis in Myocardial Infarction 28 trial; COMMIT/CCS-2 = Clopidogrel and Metoprolol in Myocardial Infarction Trial/Second Chinese Cardiac Study.
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Figure 3 Composite Efficacy Outcome Stratified by Clopidogrel Use
Efficacy of enoxaparin over unfractionated heparin (UFH) in reducing death, myocardial infarction (MI), recurrent ischemia, or stroke stratified by clopidogrel use. ORadj = adjusted odds ratio.
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Figure 4 Events Prevented or Caused by Treatment With ENOX Rather Than UFH Stratified by Clopidogrel Use
The absolute number of events prevented (negative value) or provoked (positive value) per 1,000 patients treated with enoxaparin (ENOX) rather than unfractionated heparin (UFH). MI = myocardial infarction.
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