PMID- 10549726
OWN - NLM
STAT- MEDLINE
DCOM- 19991208
LR  - 20071115
IS  - 0094-6176 (Print)
IS  - 0094-6176 (Linking)
VI  - 25 Suppl 3
DP  - 1999
TI  - Low molecular weight heparins in the management of unstable angina/non-Q-wave 
      myocardial infarction.
PG  - 113-21
AB  - The safety and efficacy of enoxaparin, dalteparin, and nadroparin have been 
      studied in five major trials in the treatment of unstable angina/non-Q-wave 
      myocardial infarction (UA/NQWMI). To date, enoxaparin is the only low molecular 
      weight heparin (LMWH) to have demonstrated superiority over unfractionated 
      heparin (UFH) in preventing clinical endpoints in this indication, including a 
      composite triple endpoint of death, myocardial infarction, and need for 
      revascularization. Equivalent clinical benefits were obtained with enoxaparin in 
      two major phase III randomized trials (ESSENCE, TIMI 11B), and were not 
      accompanied by any increased risk of major hemorrhage. A meta-analysis of data 
      from TIMI 11B and ESSENCE demonstrated that enoxaparin was associated with a 20% 
      reduction in death and serious cardiac ischemic events. The benefit appeared 
      within a few days of starting therapy, was sustained through 43 days, and has 
      been confirmed to persist one year after treatment. By contrast, in similar 
      trials, neither dalteparin nor nadroparin was shown to be superior to UFH in the 
      management of acute coronary syndromes. The benefit of enoxaparin demonstrated in 
      the ESSENCE study extended across patient subgroups and was accompanied by 
      substantial cost savings. Differences in trial design prevent direct comparisons 
      between products, but prescribing decisions should be based on the available 
      clinical trial evidence.
FAU - Cohen, M
AU  - Cohen M
AD  - Cardiac Catheterization Laboratories, Hahnemann Hospital, Philadelphia, 
      Pennsylvania 19102, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Semin Thromb Hemost
JT  - Seminars in thrombosis and hemostasis
JID - 0431155
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Angina, Unstable/*drug therapy
MH  - Animals
MH  - Clinical Trials as Topic
MH  - Disease Management
MH  - Drug Evaluation
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy
RF  - 20
EDAT- 1999/11/05 00:00
MHDA- 1999/11/05 00:01
CRDT- 1999/11/05 00:00
PHST- 1999/11/05 00:00 [pubmed]
PHST- 1999/11/05 00:01 [medline]
PHST- 1999/11/05 00:00 [entrez]
PST - ppublish
SO  - Semin Thromb Hemost. 1999;25 Suppl 3:113-21.