članak: 1 od 1  
Vojnosanitetski pregled
2007, vol. 64, br. 10, str. 655-658
jezik rada: srpski
originalan članak
doi:10.2298/VSP0710655D

Bezbednost primene enoksaparina kod starijih osoba sa akutnim infarktom miokarda
KBC Zvezdara

Sažetak

Uvod/Cilj. Enoksaparin (ENOX), niskomolekulski heparin, primenjen u akutnom infarktu miokarda (AIM), može dovesti do krvarenja. Cilj ovog rada bio je da se utvrdi da li je krvarenje češće kod bolesnika sa AIM starijih od 65 godina, odnosno starijih od 75 godina, koji primaju ENOX u odnosu na bolesnike koji primaju nefrakcionisani heparin (UFH). Metode. Među bolesnicima hospitalizovanim zbog AIM tokom tri uzastopna meseca, praćene su tri grupe parametara: demografski, ishemijski i parametri krvarenja thrombolysis in myocardial infarction (TIMI) kriterijumi, u odnosu na primenu ENOX ili UFH. Rezultati. Među 85 bolesnika lečenih od AIM, 35 (41,2%) imalo je 65 godina ili manje, 32 (38,5%) 66- 75 godina, dok je 18 bolesnika (21,2%) bilo je starije od 75 godina. Kod bolesnika sa AMI starijih od 65 godina, u odnosu na primenjeni lek (ENOX vs. UFH), ishemijske komplikacije (18,2 vs. 21,4%) bile su nesignifikantno ređe, a broj smrtnih ishoda (18,2 vs. 17,8%) nesignifikantno češći kod bolesnika koji su primali ENOX; po jedan slučaj težeg krvarenja kod bolesnika starijeg od 75 godina, odnosno manje teškog krvarenja registrovan je samo kod bolesnika koji su primili UFH. Zaključak. Primena ENOX u akutnom infarktu miokarda kod bolesnika starijih od 65 godina nije pokazala signifikantnu razliku prema primeni UFH, kako u odnosu na efikasnost, tako i u odnosu na učestalost krvarenja.

Ključne reči

Reference

Antman, E.M., Louwerenburg, H.W., Baars, H.F., Wesdorp, J.C.L., Hamer, B., Bassand, J., Bigonzi, F., Pisapia, G., Gibson, C.M., Heidbuchel, H., Braunwald, E., van de Werf, F. (2002) Enoxaparin as adjunctive antithrombin therapy for ST-elevation myocardial infarction: Results of the ENTIRE-Thrombolysis in Myocardial Infarction (TIMI) 23 Trial. Circulation, 105(14): 1642-9
Antman, E.M., Morrow, D.A., McCabe, C.H., Murphy, S.A., Ruda, M., i dr. (2006) Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. New England Journal of Medicine, 354(14), 1477-1488
Antman, E.M., McCabe, C.H., Gurfinkel, E.P., Turpie, A.G., Bernink, P.J., Salein, D., de Bayes, L.A., Fox, K., Lablanche, J.M., Radley, D., Premmereur, J., Braunwald, E. (1999) Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial. Circulation, 100(15): 1593-601
Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 Investigators (2001) Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: The ASSENT-3 randomised trial in acute myocardial infarction. Lancet, 358(9282): 605-13
Blazing, M.A., Lemos, J.A., White, H.D., Fox, K.A.A., Verheugt, F.W.A., i dr. (2004) Safety and efficacy of enoxaparin vs unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes who receive tirofiban and aspirin: A randomized controlled trial. JAMA, 292(1): 55-64
Cohen, M., Demers, C., Gurfinkel, E.P., Turpie, A.G., Fromell, G.J., Goodman, S., Langer, A., Califf, R.M., Fox, K.A., Premmereur, J., Bigonzi, F. (1997) A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. N Engl J Med, 337(7): 447-52
Cohen, M., Gensini, G.F., Maritz, F., Gurfinkel, E.P., Huber, K., Timerman, A., Krzeminska-Pakula, M., Danchin, N., White, H.D., Santopinto, J., Bigonzi, F., Hecquet, C., Vittori, L., TETAMI Investigators (2003) The safety and efficacy of subcutaneous enoxaparin versus intravenous unfractionated heparin and tirofiban versus placebo in the treatment of acute ST-segment elevation myocardial infarction patients ineligible for reperfusion (TETAMI): A randomized. J Am Coll Cardiol, 42(8): 1348-56
Cohen, M., Theroux, P., Borzak, S., Frey, M.J., White, H.D., van Mieghem, W., Senatore, F., Lis, J., Mukherjee, R., Harris, K., Bigonzi, F., ACUTE II Investigators (2002) Randomized double-blind safety study of enoxaparin versus unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes treated with tirofiban and aspirin: The ACUTE II study. The Antithrombotic Combination Using Tirofiban. Am Heart J, 144(3): 470-7
Ferguson, J.J., Califf, R.M., Antman, E.M., Cohen, M., Grines, C.L., Goodman, S., Kereiakes, D.J., Langer, A., Mahaffey, K.W., Nessel, C.C. (2004) Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: Primary results of the SYNERGY randomized trial. JAMA, 292(1): 45-54
Goodman, S.G., Fitchett, D., Armstrong, P.W., Tan, M., Langer, A., Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment (INTERACT) Trial Investigators (2003) Randomized evaluation of the safety and efficacy of enoxaparin versus unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes receiving the glycoprotein IIb/IIIa inhibitor eptifibatide. Circulation, 107(2): 238-44
Montalescot, G., Bal--Sollier, C., Chibedi, D., Collet, J., Soulat, T., Dalby, M., Choussat, R., Cohen, A., Slama, M., Steg, P., i dr. (2003) Comparison of effects on markers of blood cell activation of enoxaparin, dalteparin, and unfractionated heparin in patients with unstable angina pectoris or non-ST-segment elevation acute myocardial infarction (the ARMADA study). Am J Cardiol, 91(8): 925-30
Montalescot, G., White, H.D., Gallo, R., Cohen, M., Steg, G.P., Aylward, P.E.G., Bode, C., Chiariello, M., King, S.B.I.I.I., Harrington, R.A., Desmet, W.J., Macaya, C., Steinhubl, S.R. (2006) Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. New England Journal of Medicine, 355(10), 1006-1017
Ross, A.M., Molhoek, P., Lundergan, C., Knudtson, M., Draoui, Y., Regalado, L., le Louer, V., Bigonzi, F., Schwartz, W., de Jong, E., Coyne, K., HART II Investigators (2001) Randomized comparison of enoxaparin, a low-molecular-weight heparin, with unfractionated heparin adjunctive to recombinant tissue plasminogen activator thrombolysis and aspirin: Second trial of Heparin and Aspirin Reperfusion Therapy (HART II). Circulation, 104(6): 648-52
Sabatine, M.S., Morrow, D.A., Montalescot, G., Dellborg, M., Leiva-Pons, J.L., Keltai, M., Murphy, S.A., McCabe, C.H., Gibson, M.C., Cannon, C.P., Antman, E.M., Braunwald, E. (2005) Angiographic and clinical outcomes in patients receiving low-molecular-weight heparin versus unfractionated heparin in st-elevation myocardial infarction treated with fibrinolytics in the clarity-timi 28 trial. Circulation, 112(25), 3846-3854
Simoons, M., Krzemiñska-Pakula, M., Alonso, A., Goodman, S., Kali, A., Loos, U., Gosset, F., Louer, V., Bigonzi, F., AMI-SK Investigator (2002) Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study. Eur Heart J, 23(16): 1282-90
Wallentin, L., Goldstein, P., Armstrong, P.W., Granger, C.B., Adgey, A.A.J., Arntz, H.R., Bogaerts, K., Danays, T., Lindahl, B., Makijarvi, M., Verheugt, F., van Werf, F. (2003) Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: The Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 PLUS randomiz. Circulation, 108(2): 135-42