ExTRACT-TIMI 25

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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. - PowerPoint PPT Presentation

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  • ExTRACT-TIMI 25Enoxaparin and Thrombolysis Reperfusion for ACute Myocardial Infarction TreatmentThrombolysis In Myocardial Infarction Study 25

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

  • ExTRACT-TIMI 25: Study design*Aged 75 yr: no IV bolus, 0.75 mg/kg sc q12h; CrCl
  • ExTRACT-TIMI 25: Medical history and prior treatmentsAntman EM et al. N Engl J Med. 2006;354:1477-88.

  • ExTRACT-TIMI 25: Baseline characteristicsAntman EM et al. N Engl J Med. 2006;354:1477-88.

  • ExTRACT-TIMI 25: Baseline treatmentAntman EM et al. N Engl J Med. 2006;354:1477-88.

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

  • ExTRACT-TIMI 25: Significant reduction in primary end pointDeath, MI at 30 daysAntman EM et al. N Engl J Med. 2006;354:1477-88.15129630255101520030End point (%)Days after randomizationEnoxaparinUFHRR 0.83(0.770.90)P < 0.001

  • ExTRACT-TIMI 25: Significant reduction in major secondary end pointDeath, MI, urgent revascularization at 30 daysAntman EM et al. N Engl J Med. 2006;354:1477-88.15129630255101520030EnoxaparinRR 0.81(0.750.87)P < 0.001RR (48 hr) 0.88(0.790.98)P = 0.02End point (%)UFH2Days after randomization

  • ExTRACT-TIMI 25: Safety outcomes at 30 days%Antman EM et al. N Engl J Med. 2006;354:1477-88.*Primary safety outcome (includes ICH)012Relative risk (95% CI)Favors enoxaparinFavors UFH

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  • ExTRACT-TIMI 25: Net clinical benefit at 30 days%Antman EM et al. N Engl J Med. 2006;354:1477-88.0.7511.25Relative risk (95% CI)Favors enoxaparinFavors UFH

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

  • ExTRACT-TIMI 25: SummaryIn STEMI patients, treatment with enoxaparin throughout the index of hospitalization vs UFH for 48 hours demonstrated:Superior reduction in ischemic eventsIncrease 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 fibrinolysisAntman EM et al. N Engl J Med. 2006;354:1477-88.

  • ExTRACT-TIMI 25: Clinical implicationsAntman EM et al. N Engl J Med. 2006;354:1477-88.Nonfatal MIUrgent revascularizationDeathNonfatal major bleeding

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