Original title: A direct comparison of intravenous enoxaparin with unfractionated heparin in primary percutaneous coronary intervention (from the ATOLL trial). Reference: Collet et al. Am J Cardiol. 2013; Epub ahead of print.

ATOLL study analysis suggests that enoxaparin is superior to unfractionated heparin in reducing ischemic events and mortality in patients  suffering ST elevation acute myocardial infarction (STEMI) undergoing primary angioplasty.

 This study randomized 910 patients undergoing STEMI to receive intravenous enoxaparin (0.5 mg / kg) or unfractionated heparin (50-70 IU / kg if it was associated to glycoprotein IIBIIIA inhibitors or 70-100 IU / kg without IIBIIIA). After angioplasty, patients continued using their medication.

 Enoxaparin showed a non-significant reduction of 17% of the primary end point (composite of death from any cause and stroke at 30 days, failure of the procedure and bleeding unrelated to surgery requiring rehospitalization). However, the secondary end point (death, new acute coronary syndrome, or urgent revascularization at 30 days) it was significant with a 41% reduction. Enoxaparin-treated patients also showed a lower rate of major bleeding than those treated with heparin sodium. During evaluation of the net clinical benefit, this turned in favor of enoxaparin with 7.3%  versus  15.7% with the unfractionated heparin (RR 0.46, CI 0.3 to 0.7, p = 0.0002).

Conclusion:

 In the ATOLL study protocol analysis comprising more than 87% of the study population, enoxaparin was superior to unfractionated heparin in reducing ischemic endpoints and mortality. 

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