Therapy

Why?

• Half-dose tenecteplase ^a or reteplase ^a  with abciximab and heparin compared with full-dose tenecteplase or reteplase   with heparin reduces reinfarction and refractory ischaemia in hospital, but increases the risk of major haemorrhage and thrombocytopenia. 
• The addition of abciximab and heparin compared with enoxparin reduces refractory ischaemia but leads to more major haemorrhage and thrombocytopenia. ^a  

Adding enoxaparin to tenecteplase leads to less reinfarction and refractory ischaemia than adding heparin

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
myocardial infarction a	half-dose tenecteplase and abciximab and heparin	full-dose tenecteplase and unfractionated heparin	inhospital reinfarction at 30 days	4.2%	48% (26% to 64%)	49 (32 to 100)
			inhospital refractory ischaemia at 30 days	6.5%	51% (34% to 63%)	30 (22 to 50)
			major bleeding at 30 days	2.2%	-100% (-190% to -40%)	-46 (-94 to -31)
			thrombocytopenia at 30 days	1.3%	-140% (-270% to -53%)	-54 (-110 to -36)
	full-dose tenecteplase and enoxaparin	half-dose tenecteplase and abciximab and heparin	inhospital refractory ischaemia at 30 days	3.2%	-54% (-99% to -6%)	-70 (-410 to -38)
			major bleeding at 30 days	4.3%	29% (2% to 48%)	81 (42 to 1300)
			thrombocytopenia at 30 days	3.2%	63% (40% to 76%)	50 (35 to 92)