PMID- 11275921
OWN - NLM
STAT- MEDLINE
DCOM- 20010517
LR  - 20231024
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 141
IP  - 4
DP  - 2001 Apr
TI  - Prior aspirin users with acute non-ST-elevation coronary syndromes are at 
      increased risk of cardiac events and benefit from enoxaparin.
PG  - 566-72
AB  - BACKGROUND: The aim of this article was to investigate whether prior aspirin use 
      in patients with acute coronary syndromes affects clinical outcome. The Efficacy 
      Safety Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study (ESSENCE) and 
      Thrombolysis in Myocardial Infarction (TIMI) 11B trials have shown superiority of 
      enoxaparin over unfractionated heparin (UFH) in patients with unstable angina and 
      non-ST-segment elevation myocardial infarction (UA/NSTEMI). However, the 
      treatment effect of enoxaparin in the subset of patients reporting prior aspirin 
      use has not been determined. METHODS: The rate of death, myocardial infarction, 
      and urgent revascularization at days 8 and 43 after randomization was compared 
      among patients who received aspirin within the week before randomization with 
      those who did not receive aspirin in the TIMI 11B trial. A total of 3275 patients 
      (84%) were prior aspirin users. RESULTS: The admission diagnosis was similar for 
      prior and nonprior aspirin users. At both day 8 and day 43 the event rate was 
      higher for prior aspirin users than for nonprior aspirin users (odds ratio 1.6 
      [1.24-2.08], P =.0004 at day 43), even after correction for baseline 
      characteristics. Compared with those prior aspirin users taking UFH, 
      enoxaparin-treated prior aspirin users had a reduced rate of the composite end 
      point of death, myocardial infarction, and urgent revascularization at day 8 
      (odds ratio 0.82 [0.67-1.00], P =.046) and day 43 (odds ratio 0.83 [0.70-0.98], P 
      =.032). CONCLUSION: Patients with UA/NSTEMI and prior aspirin use had a 60% 
      higher risk of death and cardiac ischemic events compared with nonprior aspirin 
      users. On the basis of this subanalysis, enoxaparin is superior to UFH in all 
      patients. In prior aspirin users the benefit is more clearly demonstrated.
FAU - Santopinto, J
AU  - Santopinto J
AD  - Coronary Care Unit, Leonidas Lucero Hospital, Estomba 963 (8000), Bahia Blanca, 
      Argentina. jsantopinto@impsat1.com
FAU - Gurfinkel, E P
AU  - Gurfinkel EP
FAU - Torres, V
AU  - Torres V
FAU - Marcos, E
AU  - Marcos E
FAU - Bozovich, G E
AU  - Bozovich GE
FAU - Mautner, B
AU  - Mautner B
FAU - McCabe, C H
AU  - McCabe CH
FAU - Antman, E M
AU  - Antman EM
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 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Angina, Unstable/*drug therapy
MH  - Anticoagulants/*therapeutic use
MH  - Aspirin/therapeutic use
MH  - Double-Blind Method
MH  - Enoxaparin/*therapeutic use
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Prognosis
MH  - Risk Assessment
MH  - Syndrome
EDAT- 2001/03/29 10:00
MHDA- 2001/05/18 10:01
CRDT- 2001/03/29 10:00
PHST- 2001/03/29 10:00 [pubmed]
PHST- 2001/05/18 10:01 [medline]
PHST- 2001/03/29 10:00 [entrez]
AID - S0002-8703(01)43748-3 [pii]
AID - 10.1067/mhj.2001.113994 [doi]
PST - ppublish
SO  - Am Heart J. 2001 Apr;141(4):566-72. doi: 10.1067/mhj.2001.113994.