PMID- 11981102
OWN - NLM
STAT- MEDLINE
DCOM- 20020607
LR  - 20191105
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 12
IP  - 3
DP  - 2001 Dec
TI  - Enoxaparin in unstable angina/non-ST-segment elevation myocardial infarction: 
      treatment benefits in prespecified subgroups.
PG  - 199-206
AB  - BACKGROUND: Two large-scale phase III clinical trials, the Efficacy and Safety of 
      Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) trial and the 
      Thrombolysis in Myocardial Infarction (TIMI) 11B study, have shown the 
      low-molecular-weight heparin, enoxaparin, to be more effective than 
      unfractionated heparin (UFH) in reducing the risk of death and severe cardiac 
      events in patients with rest unstable angina and/or non-ST-segment elevation 
      myocardial infarction (NSTEMI). However, patients with NSTEMI acute coronary 
      syndromes are a heterogeneous group. METHODS: A meta-analysis using pooled data 
      from ESSENCE and TIMI 11B was performed to examine the efficacy of enoxaparin in 
      different patient subgroups. In addition, a statistical model was developed to 
      test which factors best predicted an enhanced treatment effect. RESULTS: 
      Enoxaparin was more effective than intravenous dose-adjusted UFH in reducing the 
      incidence of the composite endpoint (including death, myocardial infarction or 
      recurrent angina prompting urgent revascularization) in the majority of subgroups 
      at 43 days after randomization. Univariate analyses revealed that there was a 
      greater benefit with enoxaparin in patients with ST-segment deviation or elevated 
      cardiac enzyme markers on admission, women, nonsmokers and patients with 
      characteristics indicative of higher cardiac risk, including prior percutaneous 
      coronary interventions, being at least 65 years old, prior angina and prior 
      aspirin use. Multivariate statistical modelling of treatment effect revealed that 
      ST-segment depression and electrocardiographic changes were the best predictors 
      of an enhanced treatment effect. CONCLUSIONS: These data reinforce previous 
      evidence suggesting that enoxaparin administered subcutaneously twice daily may 
      be considered as an alternative to intravenous UFH in the acute treatment of a 
      broad range of patients with unstable coronary artery disease.
FAU - Cohen, M
AU  - Cohen M
AD  - Division of Cardiology, MCP-Hahnemann University School of Medicine, 
      Philadelphia, Pennsylvania 19102-1192, USA. cohen@tenethealth.com
FAU - Antman, E M
AU  - Antman EM
FAU - Gurfinkel, E P
AU  - Gurfinkel EP
FAU - Radley, D
AU  - Radley D
CN  - ESSENCE (Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary 
      Events) and TIMI (Thrombolysis in Myocardial Infarction) 11B Investigators
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Angina, Unstable/*drug therapy/mortality
MH  - Clinical Trials, Phase III as Topic
MH  - Electrocardiography
MH  - Enoxaparin/*administration & dosage
MH  - Female
MH  - Heparin/administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Models, Statistical
MH  - Myocardial Infarction/*drug therapy/mortality
MH  - Odds Ratio
MH  - Risk Factors
MH  - Secondary Prevention
MH  - Therapeutic Equivalency
MH  - Treatment Outcome
EDAT- 2002/05/01 10:00
MHDA- 2002/06/12 10:01
CRDT- 2002/05/01 10:00
PHST- 2002/05/01 10:00 [pubmed]
PHST- 2002/06/12 10:01 [medline]
PHST- 2002/05/01 10:00 [entrez]
AID - 10.1023/a:1015259706522 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2001 Dec;12(3):199-206. doi: 10.1023/a:1015259706522.