A Trial on Efficacy and Safety of Full Dose Tenecteplase Combined With Unfractionated Heparin (UFH) or Enoxaparin in Acute Myocardial Infarction (AMI) in the Prehospital Setting

Inclusion Criteria: * Onset of symptoms of AMI within six hours prior to randomisation * A 12-lead ECG with one of the following: ST-segment elevation ≥ 0.1 millivolt (mV) in two or more limb leads, or ≥ 0.2 mV in two or more contiguous precordial leads indicative of AMI, or left bundle-branch block * Age ≥ 18 * Informed consent received Exclusion Criteria: * Hypertension defined as blood pressure (BP) \> 180/110 mmHg (systolic blood pressure (SBP) 180 mmHg and/or diastolic blood pressure (DBP) \> 110 mmHg) on repeated measurements during current admission prior to randomisation * Use of abciximab (ReoPro ®) or other glycoprotein-IIb/IIIa antagonists within the preceding seven days * Major surgery, biopsy of a parenchymal organ, or significant trauma within two months * Any minor head trauma and any other trauma occurring after onset of the current myocardial infarction (MI) * Any known history of stroke or transient ischaemic attack or dementia * Any known structural damage of the central nervous system * Prolonged cardiopulmonary resuscitation (\> 10 min) in the previous two weeks * Current oral anticoagulation * Standard UFH (heparin sodium) \> 5000 international units (IU), or a subcutaneous (SC) therapeutic dose of any low molecular weight heparin (LMWH) within six hours of randomisation * Known thrombocytopenia (prior platelet count below 100 000 cells/μL (100 x 10\*\*9/L)) * Known renal insufficiency (prior S-creatinine \> 2.5 mg % (\> 220 μmol/L) for men and 2.0 mg % (\> 175 μmol/L)) for women * Pregnancy or lactation, parturition within the previous 30 days. Women of childbearing potential had to have a negative pregnancy test, or use a medically accepted method of birth control * Treatment with an investigational drug under another study protocol in the past seven days * Previous enrolment in this study * Known sensitivity to tenecteplase, tissue plasminogen activator (tPA), abciximab, heparin or LMWH * Any other condition that the investigator felt would place the patient at increased risk if the investigational therapy was initiated (e.g. known haemorrhagic diathesis, acute pericarditis and/or subacute bacterial endocarditis, acute pancreatitis, severe hepatic dysfunction, diabetic haemorrhagic retinopathy or other haemorrhagic ophthalmic conditions, active peptic ulceration, arterial aneurysm and known arterial/venous malformation, neoplasm with increased bleeding risk) * Inability to follow protocol and comply with follow-up requirements