1 / 14

ExTRACT-TIMI 25

ExTRACT-TIMI 25. E no x aparin and T hrombolysis R eperfusion for AC ute Myocardial Infarction T reatment – T hrombolysis I n M yocardial I nfarction Study 25. ExTRACT-TIMI 25: Background.

lilka
Télécharger la présentation

ExTRACT-TIMI 25

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ExTRACT-TIMI 25 Enoxaparin and Thrombolysis Reperfusion for ACute Myocardial Infarction Treatment–Thrombolysis In Myocardial Infarction Study 25

  2. ExTRACT-TIMI 25: Background • In STEMI patients, prolonged infusion of UFH has not been shown to prevent reocclusion following angiographically successful fibrinolytic therapy • Therefore, current recommendations limit duration of infusion to 48 hours • LMWH vs UFH provides a reliable level of anticoagulation without the need for therapeutic monitoring and with relatively greater proximal inhibition of the coagulation cascade • ExTRACT-TIMI 25 compared LMWH (enoxaparin) and UFH as adjunctive therapy for fibrinolysis in STEMI • Enoxaparin was administered for duration of hospitalization and dosed according to age and renal function LMWH = low-molecular-weight heparin UFH = unfractionated heparin Antman EM et al. N Engl J Med. 2006;354:1477-88.

  3. ExTRACT-TIMI 25: Study design N = 20,506 fibrinolytic eligible, STEMI <6 hours Randomized, double-blind, double-dummy ASA 150–325 mg, fibrinolytic (TNK, tPA, rPA, SK) UFH60 U/kg IV bolus, 12 U/kg/h median 2 days Enoxaparin 30 mg IV bolus, 1.0 mg/kg sc q12h* median 7 days Primary end points: Efficacy: Death, MI in 30 days Safety: TIMI major bleeding Net clinical benefit: Death, MI, disabling stroke, nonfatal major bleed, ICH *Aged ≥75 yr: no IV bolus, 0.75 mg/kg sc q12h; CrCl <30 mL/min: ± IV bolus, 1.0 mg/kg sc q24h Antman EM et al. Am Heart J. 2005;149:217-26.Antman EM et al. N Engl J Med. 2006;354:1477-88.

  4. ExTRACT-TIMI 25: Medical history and prior treatments Antman EM et al. N Engl J Med. 2006;354:1477-88.

  5. ExTRACT-TIMI 25: Baseline characteristics Antman EM et al. N Engl J Med. 2006;354:1477-88.

  6. ExTRACT-TIMI 25: Baseline treatment Antman EM et al. N Engl J Med. 2006;354:1477-88.

  7. ExTRACT-TIMI 25: Cardiac medications during hospitalization Antman EM et al. N Engl J Med. 2006;354:1477-88.

  8. ExTRACT-TIMI 25: Significant reduction in primary end point Death, MI at 30 days 15 UFH 12 9 Enoxaparin End point(%) 6 RR 0.83 (0.77–0.90) P < 0.001 3 0 0 5 10 15 20 25 30 Days after randomization Antman EM et al. N Engl J Med. 2006;354:1477-88.

  9. ExTRACT-TIMI 25: Significant reduction in major secondary end point Death, MI, urgent revascularization at 30 days UFH 15 12 Enoxaparin 9 End point(%) RR 0.81 (0.75–0.87) P < 0.001 6 RR (48 hr) 0.88 (0.79–0.98) P = 0.02 3 0 0 2 5 10 15 20 25 30 Days after randomization Antman EM et al. N Engl J Med. 2006;354:1477-88.

  10. ExTRACT-TIMI 25: Safety outcomes at 30 days % Favorsenoxaparin FavorsUFH 0 1 2 Relative risk (95% CI) *Primary safety outcome (includes ICH) Antman EM et al. N Engl J Med. 2006;354:1477-88.

  11. ExTRACT-TIMI 25: Net clinical benefit at 30 days % Favorsenoxaparin FavorsUFH 0.75 1 1.25 Relative risk (95% CI) Antman EM et al. N Engl J Med. 2006;354:1477-88.

  12. ExTRACT-TIMI 25: Overall results • Primary efficacy end pointRate of death or MI was significantly lower with enoxaparin vs UFH (P < 0.001) • Major secondary end pointRate of death, MI or urgent revascularization was significantly lower with enoxaparin vs UFH (P < 0.001) • Safety outcomeRate of major bleeding* in both groups: 2.1% enoxaparin vs 1.4% UFH (P < 0.001) *TIMI criteria Antman EM et al. N Engl J Med. 2006;354:1477-88.

  13. ExTRACT-TIMI 25: Summary • In STEMI patients, treatment with enoxaparin throughout the index of hospitalization vs UFH for48 hours demonstrated: • Superior reduction in ischemic events • Increase in episodes of major bleeding • ExTRACT-TIMI 25 results show that treatment strategy with enoxaparin is preferable to the current standard of UFH to support fibrinolysis Antman EM et al. N Engl J Med. 2006;354:1477-88.

  14. ExTRACT-TIMI 25: Clinical implications Nonfatal MI Urgentrevascularization Death Nonfatal major bleeding Antman EM et al. N Engl J Med. 2006;354:1477-88.

More Related