liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
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
Show others and affiliations
2003 (English)In: European Heart Journal, ISSN 0195-668X, Vol. 24, no 10, 897-908 p.Article in journal (Refereed) Published
Abstract [en]

Background: Current thrombolytic-antithrombotic regimens in acute myocardial infarction (AMI) are limited by incomplete early coronary reperfusion and by reocclusion and reinfarction. We compared the effects of low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) as an adjunct to recombinant tissue-plasminogen activator (alteplase) on coronary artery patency and clinical outcomes in AMI. Methods: Patients with AMI treated with alteplase (n = 439) were randomised to either subcutaneous dalteparin (120 IU/kg every 12 h) for 4-7 days or intravenous infusion of UFH for 48 h. Coronary angiography was performed between day 4 and hospital discharge. Clinical events and safety were evaluated until day 30. Results: Overall there were higher thrombolysis in myocardial infarction (TIMI) flows in the infarct related coronary artery in the dalteparin group (p = 0.01 6). The predefined primary end-point, TIMI grade 3 flow, did not reach statistical significance (dalteparin 69.3% versus heparin 62.5%, p = 0.163). However, TIMI 0-1 flow (13.4 versus 24.4%, p = 0.006) and its combination with intraluminal thrombus (27.9 versus 42.0%, p = 0.003) were less common in the dalteparin group. During the period of randomised treatment there were less myocardial reinfarctions in the dalteparin group (p = 0.010) but after cessation of dalteparin there were more reinfarctions resulting in no difference in death or MI at 30 days. There were no significant differences in major bleeding or stroke after 30 days. Conclusions: In alteplase treated AMI adjunctive dalteparin for 4-7 days seems to reduce the risk of early coronary artery occlusion and reinfarction. However, early after cessation of treatment there is a raised risk of events, which might eliminate any long-term gains. ⌐ 2003 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Place, publisher, year, edition, pages
2003. Vol. 24, no 10, 897-908 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-27168DOI: 10.1016/S0195-668X(03)00006-XLocal ID: 11817OAI: diva2:247719
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-09-11

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Swahn, Eva
By organisation
Faculty of Health SciencesCardiologyDepartment of Cardiology
In the same journal
European Heart Journal
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 18 hits
ReferencesLink to record
Permanent link

Direct link