http://www.theheart.org/web_slides/1136041.do A randomized sutdy on EXTRACT-TIMI 25 with patients with STEMI scheduled for fibrinolysis receiving enoxaparin or UFH for at least 48 hours

1. EXTRACT–TIMI 25 (Enoxaparin and
Thrombolysis Reperfusion for Acute
Myocardial Infarction Treatment—
Thrombolysis in Myocardial Infarction 25)

2. EXTRACT–TIMI 25 (Enoxaparin and Thrombolysis
Reperfusion for Acute Myocardial Infarction Treatment—
Thrombolysis in Myocardial Infarction 25)
EM Antman (Brigham and Women’s Hospital, Boston, MA)
American College of Cardiology 2006 Scientific Sessions
• Background:
The use of UFH requires frequent monitoring to adjust infusion rate to
maintain a therapeutic range of anticoagulation
LMWHs such as enoxaparin provide a reliable level of anticoagulation
without the need for therapeutic monitoring and offer the advantage of
subcutaneous administration
• Population and treatment:
20 506 patients with STEMI scheduled for fibrinolysis randomized to
receive enoxaparin or UFH for at least 48 hours
• Primary outcome:
Death or nonfatal recurrent MI through 30 days
UFH=unfractionated heparin
LMWH=low-molecular-weight heparin

3. EXTRACT–TIMI 25: Results
• Primary end point significantly reduced in the enoxaparin arm—primarily driven
by a 33% reduction in nonfatal MI
Outcomes at 30 days
Outcome Enoxaparin UFH Relative p
(n=10 256), (n=10 223) risk
n (%) n, (%)
Primary end point 1017 (9.9) 1223 (12.0) 0.83 <0.001
Death 708 (6.9) 765 (7.5) 0.92 0.11
Nonfatal MI 309 (3.0) 458 (4.5) 0.67 <0.001
Urgent revascularization 213 (2.1) 286 (2.8) 0.74 <0.001
Death, nonfatal MI, or urgent revascularization 1199 (11.7) 1479 (14.5) 0.81 <0.001
Major bleeding (including ICH) 211 (2.1) 138 (1.4) 1.53 <0.001
Net clinical benefit: death, nonfatal MI, or nonfatal ICH 1040 (10.1) 1250 (12.2) 0.83 <0.001
Net clinical benefit: death, nonfatal MI, or nonfatal major bleeding 1128 (11.0) 1305 (12.8) 0.86 <0.001
ICH=intracerebral hemorrhage

4. EXTRACT–TIMI 25: Commentary*
"EXTRACT–TIMI 25 appears to confirm a recent meta-analysis that showed an
advantage of low-molecular-weight heparin [LMWH] over UFH in lytic patients, but
with one major caveat—enoxaparin was given for seven days whereas UFH was
given for only two."
- Dr Eric Bates
"The one message I have received most clearly from [this trial] is that we now
know it is safe to use enoxaparin with thrombolysis in the elderly if we reduce the
dose."
- Dr Paul Armstrong
*All comments from Experts clash over relative benefits of enoxaparin and fondaparinux in EXTRACT–
TIMI 25 and OASIS–6 (http://www.theheart.org/article/674653.do)

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