Enoxaparin vs. UFH as Adjunct to Fibrinolysis in STEMI

In this multicenter trial, 20,506 patients receiving fibrinolysis (80% with a fibrin-specific agent) for ST-segment-elevation MI (STEMI) were randomly assigned to adjunctive enoxaparin or unfractionated heparin (UFH). Enoxaparin was given as a 30-mg IV bolus followed by subcutaneous administration (1 mg/kg) every 12 hours until hospital discharge; the 12% of patients age 75 or older did not get the bolus, and their subcutaneous doses were 0.75 mg/kg. UFH was given intravenously as 60-U/kg bolus (maximum, 4000 U) and continued at 12 U/kg/hour, titrated according to an activated partial-thromboplastin time protocol, for at least 48 hours. The trial was funded by enoxaparin’s manufacturer, to which some of the researchers report financial ties…