Comparison of bleeding complications and 3-year survival with low-molecular-weight heparin versus unfractionated heparin for acute myocardial infarction: The FAST-MI registry

作者：Puymirat Etienne^*; Aissaoui Nadia; Silvain Johanne; Bonello Laurent; Cuisset Thomas; Motreff Pascal; Bataille Vincent; Durand Eric; Cottin Yves; Simon Tabassome; Danchin Nicolas

来源：Archives of Cardiovascular Diseases, 2012, 105(6-7): 347-354.

DOI：10.1016/j.acvd.2012.04.002

• Acute myocardial infarction
• Bleeding
• Low-molecular-weight heparin
• Unfractionated heparin

Background. - Recent clinical studies suggest that low-molecular-weight heparin (LMWH) could be an effective and safe alternative to unfractionated heparin (UFH) for patients with acute myocardial infarction (AMI). %26lt;br%26gt;Aims. - To assess the impact of anticoagulant choice (LMWV vs UFH) on bleeding, the need for blood transfusion and 3-year clinical outcomes in AMI patients from the FAST-MI registry. %26lt;br%26gt;Methods. - FAST-MI was a nationwide registry compiled in France over 1 month in 2005, which included consecutive AMI patients admitted to an intensive care unit less than 48 hours from symptom onset in 223 participating centres. %26lt;br%26gt;Results. - A total of 2854 patients treated with heparins were included. The risks of major bleeding or transfusion (3.0% vs 7.0%) and in-hospital death (3.2% vs 9.2%) were lower with LAWN compared with UFH, a difference that persisted after multivariable adjustment (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.34-0.76 and OR 0.53, 95% CI 0.37-0.76, respectively). Three-year survival, and stroke and reinfarction-free survival risks were also higher with LMWH compared with UFH (adjusted hazard ratio [HR] 0.73, 95% CI 0.61-0.87 and HR 0.73, 95% CI 0.62-0.85, respectively). In two cohorts of patients matched on propensity score for receiving LMWH and with similar baseline characteristics (834 patients per group), major bleeding and transfusion rates were lower while the 3-year survival rate was significantly higher in patients receiving LMWH. %26lt;br%26gt;Conclusion. - Our data suggest that the use of LMWH in AMI patients may have a better benefit/risk profile than UFH, in terms of bleeding, need for transfusion and long-term survival.

• 出版日期2012-7