AIMS: To establish whether the addition of enoxaparin (a low-molecular-weight heparin) to streptokinase therapy improves early and sustained coronary patency and clinical outcome in patients with evolving myocardial infarction. METHODS AND RESULTS: A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30 mg) and subcutaneous injections (1mg x kg(-1), twice daily) of enoxaparin (n=253), or placebo (n=243) for 3-8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90 min and 180 min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180 min was observed in 36%, 44% and 19% in the enoxaparin group vs 25%, 44% and 31% in the placebo group, respectively (P=0.004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70% vs 58%, P=0.01). Combined TIMI-2 and -3 flow was also improved (88% vs 72%, P=0.001), as was TIMI frame count (P=0.003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13% vs 21%, P=0.03). CONCLUSION: Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5-10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion.

Adult, Aged, Drug Therapy, Combination, Electrocardiography, Enoxaparin/adverse effects/*therapeutic use, Female, Fibrinolytic Agents/adverse effects/*therapeutic use, Humans, Male, Middle aged, Myocardial Infarction/*drug therapy, Myocardial Reperfusion/methods, Recurrence, Research Support, Non-U.S. Gov't, Streptokinase/*therapeutic use, Thrombolytic Therapy/*methods, Treatment Outcome
hdl.handle.net/1765/9950
European Heart Journal
Erasmus MC: University Medical Center Rotterdam

Krzeminska-Pakula, M, Alonso, A.M.F, Goodman, S.G, Kali, A, Loos, U, Gosset, F, … Simoons, M.L. (2002). Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study. European Heart Journal. Retrieved from http://hdl.handle.net/1765/9950