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. 1992 Feb;67(2):122–128. doi: 10.1136/hrt.67.2.122

Effect of early intravenous heparin on coronary patency, infarct size, and bleeding complications after alteplase thrombolysis: results of a randomised double blind European Cooperative Study Group trial.

D P de Bono 1, M L Simoons 1, J Tijssen 1, A E Arnold 1, A Betriu 1, C Burgersdijk 1, L López Bescos 1, E Mueller 1, M Pfisterer 1, F Van de Werf 1, et al.
PMCID: PMC1024740  PMID: 1540431

Abstract

OBJECTIVE--To determine whether concomitant treatment with intravenous heparin affects coronary patency and outcome in patients treated with alteplase thrombolysis for acute myocardial infarction. DESIGN--Double blind randomised trial. TREATMENT REGIMENS--Alteplase 100 mg (not weight adjusted) plus aspirin (250 mg intravenously followed by 75-125 mg on alternate days) plus heparin (5000 units intravenously followed by 1000 units hourly without dose adjustment) was compared with alteplase plus aspirin plus placebo for heparin. SETTING--19 cardiac centres in six European countries. SUBJECTS--652 patients aged 21-70 years with clinical and electrocardiographic features of infarcting myocardium in whom thrombolytic therapy could be started within six hours of the onset of major symptoms. MAIN OUTCOME MEASURE--Angiographic coronary patency 48-120 hours after randomisation. RESULTS--Coronary patency (TIMI grades 2 or 3) was 83.4% in the heparin group and 74.7% in the group given placebo for heparin. The relative risk of an occluded vessel in the heparin treated group was 0.66 (95% confidence interval 0.47 to 0.93). Mortality was the same in both groups. There were non-significant trends towards a smaller enzymatic infarct size and a higher incidence of bleeding complications in the group treated with heparin. CONCLUSIONS--Concomitant intravenous heparin improves coronary patency in patients with alteplase. Whether this can be translated into improved clinical benefit needs to be to be tested in a larger trial.

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Selected References

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  1. Bleich S. D., Nichols T. C., Schumacher R. R., Cooke D. H., Tate D. A., Teichman S. L. Effect of heparin on coronary arterial patency after thrombolysis with tissue plasminogen activator in acute myocardial infarction. Am J Cardiol. 1990 Dec 15;66(20):1412–1417. doi: 10.1016/0002-9149(90)90525-6. [DOI] [PubMed] [Google Scholar]
  2. Chesebro J. H., Knatterud G., Roberts R., Borer J., Cohen L. S., Dalen J., Dodge H. T., Francis C. K., Hillis D., Ludbrook P. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation. 1987 Jul;76(1):142–154. doi: 10.1161/01.cir.76.1.142. [DOI] [PubMed] [Google Scholar]
  3. Collins R., Flather M., Peto R. GISSI-2: 10% reduction in mortality with heparin in acute myocardial infarction? Lancet. 1990 Aug 18;336(8712):439–440. doi: 10.1016/0140-6736(90)91985-j. [DOI] [PubMed] [Google Scholar]
  4. Hsia J., Hamilton W. P., Kleiman N., Roberts R., Chaitman B. R., Ross A. M. A comparison between heparin and low-dose aspirin as adjunctive therapy with tissue plasminogen activator for acute myocardial infarction. Heparin-Aspirin Reperfusion Trial (HART) Investigators. N Engl J Med. 1990 Nov 22;323(21):1433–1437. doi: 10.1056/NEJM199011223232101. [DOI] [PubMed] [Google Scholar]
  5. Rentrop K. P., Feit F., Sherman W., Thornton J. C. Serial angiographic assessment of coronary artery obstruction and collateral flow in acute myocardial infarction. Report from the second Mount Sinai-New York University Reperfusion Trial. Circulation. 1989 Nov;80(5):1166–1175. doi: 10.1161/01.cir.80.5.1166. [DOI] [PubMed] [Google Scholar]
  6. Topol E. J., George B. S., Kereiakes D. J., Stump D. C., Candela R. J., Abbottsmith C. W., Aronson L., Pickel A., Boswick J. M., Lee K. L. A randomized controlled trial of intravenous tissue plasminogen activator and early intravenous heparin in acute myocardial infarction. Circulation. 1989 Feb;79(2):281–286. doi: 10.1161/01.cir.79.2.281. [DOI] [PubMed] [Google Scholar]
  7. Van de Werf F., Arnold A. E. Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction. BMJ. 1988 Nov 26;297(6660):1374–1379. doi: 10.1136/bmj.297.6660.1374. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Verstraete M., Bernard R., Bory M., Brower R. W., Collen D., de Bono D. P., Erbel R., Huhmann W., Lennane R. J., Lubsen J. Randomised trial of intravenous recombinant tissue-type plasminogen activator versus intravenous streptokinase in acute myocardial infarction. Report from the European Cooperative Study Group for Recombinant Tissue-type Plasminogen Activator. Lancet. 1985 Apr 13;1(8433):842–847. doi: 10.1016/s0140-6736(85)92208-1. [DOI] [PubMed] [Google Scholar]
  9. Verstraete M., Bleifeld W., Brower R. W., Charbonnier B., Collen D., de Bono D. P., Dunning A. J., Lennane R. J., Lubsen J., Mathey D. G. Double-blind randomised trial of intravenous tissue-type plasminogen activator versus placebo in acute myocardial infarction. Lancet. 1985 Nov 2;2(8462):965–969. doi: 10.1016/s0140-6736(85)90523-9. [DOI] [PubMed] [Google Scholar]
  10. White H. D. GISSI-2 and the heparin controversy. Lancet. 1990 Aug 4;336(8710):297–298. doi: 10.1016/0140-6736(90)91818-u. [DOI] [PubMed] [Google Scholar]
  11. Wilcox R. G., von der Lippe G., Olsson C. G., Jensen G., Skene A. M., Hampton J. R. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet. 1988 Sep 3;2(8610):525–530. doi: 10.1016/s0140-6736(88)92656-6. [DOI] [PubMed] [Google Scholar]
  12. van der Laarse A., Hermens W. T., Hollaar L., Jol M., Willems G. M., Lemmers H. E., Liem A. H., Souverijn J. H., Oudhof J. H., de Hooge J. Assessment of myocardial damage in patients with acute myocardial infarction by serial measurement of serum alpha-hydroxybutyrate dehydrogenase levels. Am Heart J. 1984 Feb;107(2):248–260. doi: 10.1016/0002-8703(84)90372-7. [DOI] [PubMed] [Google Scholar]

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