PMID- 11728348
OWN - NLM
STAT- MEDLINE
DCOM- 20020103
LR  - 20190622
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 88
IP  - 11
DP  - 2001 Dec 1
TI  - Prospective comparison of hemorrhagic complications after treatment with 
      enoxaparin versus unfractionated heparin for unstable angina pectoris or 
      non-ST-segment elevation acute myocardial infarction.
PG  - 1230-4
AB  - Patients with unstable angina pectoris (UAP) or non-ST-segment elevation acute 
      myocardial infarction (AMI) are at risk of death or recurrent ischemic events, 
      despite receiving aspirin and unfractionated heparin (UFH). This study 
      investigates the effect of the low molecular weight heparin, enoxaparin, on the 
      incidence of hemorrhage and thrombocytopenia in relation to baseline 
      characteristics and subsequent invasive procedures. Rates of hemorrhage and 
      thrombocytopenia were analyzed for UAP or non-ST-segment elevation AMI in 
      patients included in the prospective, randomized, double-blind Efficacy and 
      Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) study. 
      Patients received either enoxaparin or UFH, plus aspirin, for 2 to 8 days. The 
      overall rate of major hemorrhage (at 30 days) was comparable between the 2 groups 
      (6.5% for enoxaparin vs. 7.0% for UFH, p = 0.6). The rate of major hemorrhage 
      while on treatment was slightly higher in the enoxaparin group, but this was not 
      significant (1.1% vs 0.7% for UFH, p = 0.204), as was the rate of major 
      hemorrhage within 48 hours of coronary artery bypass grafting performed within 12 
      hours of treatment. However, the rate of minor hemorrhage was significantly 
      higher in the enoxaparin group, with the majority being injection-site ecchymoses 
      or hematomas (11.9% vs. 7.2% with UFH, p <0.001). Thrombocytopenia (platelet 
      count <100,000 per mm(3)) occurred mainly in association with coronary bypass 
      surgery, with a similar rate in both groups. Thus, enoxaparin is a well-tolerated 
      alternative to UFH in the management of UAP or non-ST-segment elevation AMI. 
      Despite the more effective antithrombotic effect, which results in fewer ischemic 
      events, enoxaparin is not associated with an increase in the rate of major 
      hemorrhagic complications, and is not significantly associated with 
      thrombocytopenia, but is associated with an increase in minor injection site 
      ecchymosis.
FAU - Berkowitz, S D
AU  - Berkowitz SD
AD  - Duke University Medical Center, Duke Clinical Research Institute, Durham, North 
      Carolina, USA.
FAU - Stinnett, S
AU  - Stinnett S
FAU - Cohen, M
AU  - Cohen M
FAU - Fromell, G J
AU  - Fromell GJ
FAU - Bigonzi, F
AU  - Bigonzi F
CN  - ESSENCE Investigators
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 J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Antifibrinolytic Agents)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Angina, Unstable/diagnosis/*drug therapy
MH  - Antifibrinolytic Agents/*adverse effects/therapeutic use
MH  - Double-Blind Method
MH  - *Electrocardiography
MH  - Enoxaparin/*adverse effects/therapeutic use
MH  - Female
MH  - Hemorrhage/*chemically induced
MH  - Heparin/*adverse effects/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*drug therapy
MH  - Prospective Studies
MH  - Thrombocytopenia/chemically induced
EDAT- 2001/12/01 10:00
MHDA- 2002/01/05 10:01
CRDT- 2001/12/01 10:00
PHST- 2001/12/01 10:00 [pubmed]
PHST- 2002/01/05 10:01 [medline]
PHST- 2001/12/01 10:00 [entrez]
AID - S0002914901020823 [pii]
AID - 10.1016/s0002-9149(01)02082-3 [doi]
PST - ppublish
SO  - Am J Cardiol. 2001 Dec 1;88(11):1230-4. doi: 10.1016/s0002-9149(01)02082-3.