PMID- 11011339
OWN - NLM
STAT- MEDLINE
DCOM- 20001102
LR  - 20190626
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 140
IP  - 4
DP  - 2000 Oct
TI  - Superiority of enoxaparin versus unfractionated heparin for unstable 
      angina/non-Q-wave myocardial infarction regardless of activated partial 
      thromboplastin time.
PG  - 637-42
AB  - BACKGROUND: Whether the clinical superiority of enoxaparin versus unfractionated 
      heparin (UFH) depends on a more stable antithrombotic effect or the proportion of 
      patients not reaching the therapeutic level with UFH has not been addressed. 
      METHODS: All patients participating in the Thrombolysis In Myocardial Infarction 
      11B trial who received UFH and had sufficient activated partial thromboplastin 
      time (aPTT) data (n = 1893) were compared with patients who received enoxaparin 
      (n = 1938). Patients receiving UFH were divided into 3 categories depending on 
      mean aPTT values throughout 48 hours: subtherapeutic, for those in whom the 
      average aPTT fell below 55 seconds; therapeutic, between 55 and 85 seconds; and 
      supratherapeutic, longer than 85 seconds. Events and bleeding rates were 
      determined at 48 hours. RESULTS: A small portion of patients (6. 7%) had a 
      subtherapeutic average aPTT value (n = 127). Forty-seven percent of patients (n = 
      891) fell within the therapeutic range, and 46% were in the supratherapeutic 
      level (n = 875). Event rates were 7. 0% in the UFH group versus 5.4% with 
      enoxaparin (P =.039). Events rates were higher in every aPTT strata compared with 
      enoxaparin and statistically significant in the supratherapeutic group (odds 
      ratio 0.65; 95% confidence interval, 0.47-0.89). Major bleeding rates were 0%, 
      0.6%, and 0.9% for the subtherapeutic, target, and supratherapeutic strata, 
      respectively, and 0.8% with enoxaparin. Minor hemorrhages occurred in 5.1% of 
      patients receiving enoxaparin versus 3.9%, 2%, and 2.3%, respectively, for the 
      UFH subgroups (P <. 001 for all UFH groups vs enoxaparin). CONCLUSIONS: 
      Enoxaparin showed a better clinical profile compared with every level of 
      anticoagulation with UFH. Potential mechanisms for enoxaparin superiority are 
      stable antithrombotic activity, lack of rebound thrombosis, and intrinsic 
      superiority.
FAU - Bozovich, G E
AU  - Bozovich GE
AD  - Favaloro Foundation, Buenos Aires, and Brigham and Women's Hospital, Boston, 
      Massachusetts, USA. bozovich@impsat1.com.ar
FAU - Gurfinkel, E P
AU  - Gurfinkel EP
FAU - Antman, E M
AU  - Antman EM
FAU - McCabe, C H
AU  - McCabe CH
FAU - Mautner, B
AU  - Mautner B
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 129480-74-6 (ITF 300)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Angina, Unstable/blood/*drug therapy/physiopathology
MH  - Double-Blind Method
MH  - *Electrocardiography/drug effects
MH  - Enoxaparin/*therapeutic use
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin/*analogs & derivatives/*therapeutic use
MH  - Humans
MH  - Middle Aged
MH  - Myocardial Infarction/blood/*drug therapy/physiopathology
MH  - Partial Thromboplastin Time
MH  - Prospective Studies
MH  - Safety
MH  - *Thrombolytic Therapy
EDAT- 2000/09/30 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/09/30 11:00
PHST- 2000/09/30 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/09/30 11:00 [entrez]
AID - S0002870300862882 [pii]
AID - 10.1067/mhj.2000.109921 [doi]
PST - ppublish
SO  - Am Heart J. 2000 Oct;140(4):637-42. doi: 10.1067/mhj.2000.109921.