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June 1, 2005

Reviparin in Acute Myocardial Infarction

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(21):2595-2596. doi:10.1001/jama.293.21.2595-b

To the Editor: The CREATE trial1 demonstrated an overall lower rate of hemorrhagic stroke among patients treated with reviparin (0.3%) vs that reported in previous trials of unfractionated heparin and enoxaparin,2,3 and the National Registry of Myocardial Infarction 2 trial.4 Although this finding may represent differences in pharmacological properties of reviparin and the dosing regimens, the lower age and systolic blood pressure of the study population vs that of other STEMI trials, together with the exclusion of patients at high risk of bleeding, may also have contributed to the low rate of this serious complication. Furthermore, the patients enrolled in China were older (mean age, 62.7 years) than patients from other countries but were also less likely to receive fibrinolytic therapy (52%).5 Therefore, although the CREATE trial established the role of antithrombotic therapy as an adjunct to fibrinolytics in STEMI, the optimal agent and dose remain to be determined.

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