PMID- 12535430
OWN - NLM
STAT- MEDLINE
DCOM- 20030327
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 1
DP  - 2003
TI  - Low molecular weight heparins versus unfractionated heparin for acute coronary 
      syndromes.
PG  - CD002132
AB  - BACKGROUND: Acute coronary syndromes (ACS) are an important source of morbidity 
      and mortality. Despite weak evidence for the use of unfractionated heparin (UFH) 
      for acute coronary syndromes it is considered an accepted treatment for unstable 
      angina and non-ST segment elevation myocardial infarction (MI). However, evidence 
      suggests low molecular weight heparins (LMWH) are safer and more effective than 
      UFH in the treatment and prevention of other thrombotic disorders. OBJECTIVES: To 
      assess the effects of LMWH compared to UFH for acute coronary syndromes. SEARCH 
      STRATEGY: We searched the Cochrane Controlled Trials Register (the Cochrane 
      Library issue 4, 2000), MEDLINE (January 1966 to December 2000), EMBASE (1980 to 
      December 2000) and CINAHL (1982 to December 2000) and reference lists of 
      articles. Authors of all include studies and pharmaceutical industry 
      representatives were contacted to determine if unpublished studies which met the 
      inclusion criteria were available. SELECTION CRITERIA: Randomized controlled 
      trials of subcutaneous LMWH versus intravenous UFH in people with acute coronary 
      syndromes (unstable angina or non-ST segment elevation MI). DATA COLLECTION AND 
      ANALYSIS: Two reviewers independently assessed quality of studies. Data were 
      extracted independently by two reviewers. Study authors were contacted to verify 
      and clarify missing data. MAIN RESULTS: We identified 27 potentially relevant 
      studies, 7 studies (11,092 participants) were included in this review. We found 
      no evidence for difference in overall mortality between the groups treated with 
      LMWH and UFH (RR = 1.0; 95% CI: 0.69, 1.44). Some pooled outcomes showed some 
      evidence of heterogeneity, few of the pooled outcomes were statistically 
      heterogeneous most were homogeneous. LMWH reduced the occurrence of MI (RR = 
      0.83; 95% CI: 0.70, 0.99) and the need for revascularization procedures (RR = 
      0.88; 95% CI: 0.82, 0.95). We found no evidence for difference in occurrence of 
      recurrent angina (RR = 0.83; 95% CI: 0.68, 1.02), major bleeds (RR = 1.00; 95% 
      CI: 0.80, 1.24) or minor bleeds (RR = 1.40; 95% CI: 0.66, 2.90). A decrease in 
      the incidence of thrombocytopenia (RR = 0.64; 95% CI: 0.44, 0.94) was observed 
      for patients given LMWH. From these results, 125 patients need to be treated with 
      LMWH to prevent 1 additional MI and 50 patients need to be treated to prevent 1 
      revascularization procedure. Insufficient data exist to compare different types 
      of LMWH. REVIEWER'S CONCLUSIONS: LMWH and UFH had similar risk of mortality, 
      recurrent angina, and major or minor bleeding but LMWH had decreased risk of MI, 
      revascularization and thrombocytopenia. New Trials with longer follow up are 
      required.
FAU - Magee, K D
AU  - Magee KD
AD  - Department of Emergency Medicine, Dalhousie University, Queen Elizabeth II Health 
      Sciences Centre, The New Halifax Infirmary, 1796 Summer Street, Halifax, Nova 
      Scotia, Canada, B3H 3A7. KMagee@tupdean2.med.dal.ca
FAU - Sevcik, W
AU  - Sevcik W
FAU - Moher, D
AU  - Moher D
FAU - Rowe, B H
AU  - Rowe BH
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Angina, Unstable/*drug therapy
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Humans
MH  - Injections, Intravenous
MH  - Injections, Subcutaneous
MH  - Myocardial Infarction/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Syndrome
RF  - 39
EDAT- 2003/01/22 04:00
MHDA- 2003/03/28 05:00
CRDT- 2003/01/22 04:00
PHST- 2003/01/22 04:00 [pubmed]
PHST- 2003/03/28 05:00 [medline]
PHST- 2003/01/22 04:00 [entrez]
AID - 10.1002/14651858.CD002132 [doi]
PST - ppublish
SO  - Cochrane Database Syst Rev. 2003;(1):CD002132. doi: 10.1002/14651858.CD002132.