Heart 1998;80:35-39 ( July )
Low molecular weight heparin as an adjunct to thrombolysis for acute myocardial infarction: the FATIMA study
a Department of
Cardiology, Academic Medical Centre, University of Amsterdam,
Netherlands, b Centre for Haemostasis, Thrombosis,
Atherosclerosis and Inflammation Research, Academic Medical Centre,
University of Amsterdam, c Department of Clinical Epidemiology and
Biostatistics, Academic Medical Centre, University of Amsterdam
Correspondence to: Dr R J de Winter, Academic Medical Centre, Department of Cardiology, room G3-231, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands email: r.j.dewinter{at}amc.uva.nl
Accepted for publication 16 February 1998
Objective
To
investigate the feasibility of fixed dose, weight adjusted subcutaneous
low molecular weight heparin (LMWH), with monitoring of anti-Xa levels
and assessment of coronary patency rates after three to five days,
thereby giving an initial indication of its safety and efficacy.
DesignIn 30 patients
with acute myocardial infarction, LMWH (nadroparine) was given as a
body weight adjusted intravenous bolus with thrombolysis (rt-PA
infusion) and in weight adjusted subcutaneous doses at six hours, and
every 12 hours thereafter for 72 hours. The target range was defined
prospectively as 0.35-0.70 anti-factor Xa activity (aXa) units. The
aXa level was measured every six hours. Coronary angiography was
performed in all patients within five days after the start of
thrombolytic treatment to determine patency (TIMI 2 and 3 flow) of the
infarct related artery.
ResultsThe mean (SEM)
aXa level over 72 hours was 0.52 (0.08) U/ml; from 12 hours onwards
88% of all aXa measurements were within the target range. At
angiography, a patent infarct related artery was present in 24 of the
30 patients. No major bleeding complications occurred, though minor
bleeding complications were observed in two patients.
ConclusionsThis
small study indicates that LMWH is feasible as an adjunct to
thrombolysis in patients with acute myocardial infarction. The aXa
levels were within the target range and patency rates at three to five
days were around 80%, with no major bleeding complications.
© 1998 by Heart
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