Goodman S G, Barr A, Sobtchouk A, Cohen M, Fromell G J, Laperrière L, Hill C, Langer A
Canadian Heart Research Center, Division of Cardiology, St Michael's Hospital, University of Toronto, Ontario.
J Am Coll Cardiol. 2000 Nov 1;36(5):1507-13. doi: 10.1016/s0735-1097(00)00915-3.
The goal of this study was to determine whether enoxaparin was more effective than heparin in reducing recurrent ischemic episodes.
Continuous ST segment monitoring is a simple tool for assessment of ischemia and identifies patients with a worse prognosis. Little is known about the impact of low molecular weight heparin on ST segment shift.
Patients were randomized to receive enoxaparin or heparin (mean 3.4 days). Three-lead ST segment monitoring was performed for the first 48 h (n = 220) and an additional 48 h (n = 174) after intravenous study drug discontinuation (mean 1.9 days later).
During initial monitoring, ischemia rates were similar among the heparin and enoxaparin groups (27.2% vs. 22.6%, p = 0.44); however, the time to first ischemic episode was earlier among heparin-treated patients (11 +/- 11 vs. 25 +/- 18 min, p = 0.001). After drug discontinuation, ischemic episodes occurred more frequently (44.6% vs. 25.6%, p = 0.009), and the total ischemic duration was greater among heparin patients (18 +/- 39 vs. 5 +/- 12 min/24 h, p = 0.005). Recurrent ischemia occurred more frequently after discontinuation in the heparin (46% vs. 31%, p = 0.043), but not the enoxaparin, group (18.4% vs. 25%, p = 0.33). Regardless of treatment, patients with ischemia were more likely to die or experience (re)infarction at one year (18.4% vs. 8.3%, p = 0.023).
ST segment shift occurs frequently in unstable angina/non-Q-wave myocardial infarction despite antithrombotic therapy and is associated with worse one-year prognosis. Enoxaparin is a more effective antithrombotic treatment than unfractionated heparin and leads to greater prevention of rebound ischemia.
本研究的目的是确定依诺肝素在减少复发性缺血事件方面是否比肝素更有效。
连续ST段监测是评估缺血的一种简单工具，可识别预后较差的患者。关于低分子量肝素对ST段移位的影响知之甚少。
患者被随机分配接受依诺肝素或肝素治疗（平均3.4天）。在静脉注射研究药物停药后（平均1.9天后）的前48小时（n = 220）和额外的48小时（n = 174）进行三导联ST段监测。
在初始监测期间，肝素组和依诺肝素组的缺血发生率相似（27.2%对22.6%，p = 0.44）；然而，肝素治疗的患者首次缺血发作的时间更早（11±11对25±18分钟，p = 0.001）。停药后，缺血事件更频繁发生（44.6%对25.6%，p = 0.009），肝素组患者的总缺血持续时间更长（18±39对5±12分钟/24小时，p = 0.005）。停药后，肝素组复发性缺血更频繁发生（46%对31%，p = 0.043），而依诺肝素组则不然（18.4%对25%，p = 0.33）。无论治疗如何，有缺血的患者在一年时更有可能死亡或发生（再）梗死（18.4%对8.3%，p = 0.023）。
尽管进行了抗栓治疗，但ST段移位在不稳定型心绞痛/非Q波心肌梗死中仍频繁发生，且与一年预后较差相关。依诺肝素是一种比普通肝素更有效的抗栓治疗药物，能更好地预防缺血反弹。
