Increasing evidence supports the use of antithrombotic agents in patients with ST-elevation myocardial infarction (STEMI). The main results of 2 clinical trials, ExTRACT-TIMI 25 and OASIS-6, testing 2 antithrombotic agents in STEMI patients, were recently published and presented. In the ExTRACT-TIMI 25 trial, enoxaparin was compared with heparin in patients for whom fibrinolysis was planned. The OASIS-6 trial had a more complicated design. One group of patients received either heparin or fondaparinux and underwent thrombolytic therapy; another group received either heparin or fondaparinux and underwent percutaneous coronary intervention; other patients received either fondaparinux or placebo and underwent thrombolytic therapy; additional patients received no reperfusion. Both trials had positive findings overall, but careful dissection of the data results in a more nuanced interpretation.
In this panel discussion, taped several months after publication of the data, James J. Ferguson, MD, briefly reviews the data and joins his colleagues, James Hoekstra, MD, and David A. Morrow, MD, MPH, in a thorough analysis of these studies. They discuss the strengths and weaknesses of the trial designs, their outcomes, and the likely impact of each trial on clinical practice for cardiologists and emergency department physicians.