Control Group: (n = 60, 60 analysed): no therapy
Experimental Group: (n = 43, 43 analysed): L HWML cl (a LMWH)exane 40mg/day SC OD

100% followed for 6 months
Outcome notes:

The evidence

Myocardial infarction: continued low-molecular weight heparin reduced cardiac events.

Clinical bottom line (level 1b)

  1. In patients with acute myocardial infarction, continued outpatient treatment with a low-molecular weight heparin reduced cardiac events (NNT = 3 at 6 months) .
Glick et al: American Journal of Cardiology 1996; 77: 1145-1148
Expires March 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: university hospital, Israel

103 patients (aged mean 61y (SD 10y), 79% male) acute myocardial infarction

Excluded if
  • age <25 or >80 years
  • requirement for heparin >5days
  • moderate/severe heart failure
  • bleeding tendency
  • Hb <10 or Plt <100,000
  • malignant ventricular arrythmia
  • AF beyond 24hrs
  • ventricular thrombi or pericardial effusion


    • Control Group: (n = 60, 60 analysed): no therapy
    Experimental Group: (n = 43, 43 analysed): L HWML cl (a LMWH)exane 40mg/day SC OD

    100% followed for 6 months
    Outcome notes:
    • cardiac events : (reinfarction, angina and cardiac death)
    • side effects : (gingival bleeding, Hb <10 or Plts <100,000)

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    cardiac events 6 months 26
    (43.3%)    		 6
    (14.0%)    		 68%
    (29% to 85%)    		 29.4%
    (13.1% to 45.6%)    		 3
    (2 to 8)
    side effects 6 months 8
    (13.3%)    		 1
    (2.33%)    		 83%
    (-34% to 98%)    		 11.0%
    (1.30% to 20.7%)    		 9
    (5 to 77)

    Comments

    1. Effect of LMWH protecting from bleeding side-effects are probably the result of chance.

    Citation

    1. Glick A, Kornowski R, Michowich Y, et al: Reduction of reinfarction and angina with use of low-molecular-weight heparin therapy after streptokinase (and heparin) in acute myocardial infarction. American Journal of Cardiology 1996; 77: 1145-1148
    Contributor: Bob Phillips and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient myocardial infarction and survived 5 days after streptokinase / heparin treatment
    Intervention or Exposure further 25 days LMWH
    Outcome reinfarction; angina; mortality
Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
cardiac events 6 months 26
(43.3%)		 6
(14.0%)		 68%
(29% to 85%)		 29.4%
(13.1% to 45.6%)		 3
(2 to 8)
side effects 6 months 8
(13.3%)		 1
(2.33%)		 83%
(-34% to 98%)		 11.0%
(1.30% to 20.7%)		 9
(5 to 77)

Comments

  1. Effect of LMWH protecting from bleeding side-effects are probably the result of chance.

Citation

  1. Glick A, Kornowski R, Michowich Y, et al: Reduction of reinfarction and angina with use of low-molecular-weight heparin therapy after streptokinase (and heparin) in acute myocardial infarction. American Journal of Cardiology 1996; 77: 1145-1148
Contributor: Bob Phillips and Clare Wotton, November 1999
Reviewer:

Clinical Question.
Patient myocardial infarction and survived 5 days after streptokinase / heparin treatment
Intervention or Exposure further 25 days LMWH
Outcome reinfarction; angina; mortality