PMID- 12958622
OWN - NLM
STAT- MEDLINE
DCOM- 20040521
LR  - 20041117
IS  - 0340-6245 (Print)
IS  - 0340-6245 (Linking)
VI  - 90
IP  - 3
DP  - 2003 Sep
TI  - Patterns of use of heparins in ACS. Correlates and hospital outcomes: the Global 
      Registry of Acute Coronary Events (GRACE).
PG  - 519-27
AB  - A systematic study that compares the patterns of use of unfractionated heparin 
      (UFH) and low-molecular-weight heparin (LMWH) in patients with acute coronary 
      syndromes (ACS) has, to date, not been carried out in the "real-world" setting. 
      The aim of this report is to identify patterns of use of UFH and LMWH and to 
      report their correlates and outcomes in a broad spectrum of ACS patients enrolled 
      in the observational Global Registry of Acute Coronary Events (GRACE). The use of 
      LMWH and UFH was analysed in 13,231 ACS patients according to patient history, 
      concomitant treatment and invasive procedures in US and non-US sites. Frequency 
      of use in hospitals with and without facilities for percutaneous coronary 
      interventions (PCI) was investigated, and outcomes were analysed. Results show 
      that younger patients (<60 years), those receiving antiplatelet therapies, 
      thrombolytics, beta-blockers, angiotensin-converting enzyme inhibitors, patients 
      admitted to hospitals with PCI facilities, and patients undergoing invasive 
      procedures were more likely to receive UFH, or both UFH and LMWH than LMWH alone 
      (80.1% enoxaparin, 19.9% other LMWH). LMWH was used less often in US than non-US 
      sites. After adjusting for confounding variables, patients receiving LMWH had 
      significantly lower rates of hospital mortality (P = 0.009) and major bleeding (P 
      < 0.0001). Similar results were observed in patients with ST-segment elevation 
      myocardial infarction and non-ST-segment elevation myocardial infarction or 
      unstable angina. We can conclude that UFH tends to be used more frequently than 
      LMWH, but hospital outcomes appeared to be better with LMWH after adjusting for 
      covariables.
FAU - Klein, Werner
AU  - Klein W
AD  - Medizinische Universitatsklinik Graz, Klinische Abteilung fur Kardiologie, 
      Auenbruggerplatz 5, Graz, Styria 8036, Austria. we.klein@kfunigraz.ac.at
FAU - Kraxner, Wilfried
AU  - Kraxner W
FAU - Hodl, Ronald
AU  - Hodl R
FAU - Steg, Philippe Gabriel
AU  - Steg PG
FAU - Budaj, Andrzej
AU  - Budaj A
FAU - Gulba, Dietrich
AU  - Gulba D
FAU - Sadiq, Immad
AU  - Sadiq I
FAU - van de Werf, Frans
AU  - van de Werf F
FAU - White, Kami
AU  - White K
FAU - Fox, Keith A A
AU  - Fox KA
CN  - GRACE Investigators
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Angina, Unstable/complications/drug therapy/mortality
MH  - Coronary Disease/complications/*drug therapy/mortality
MH  - *Drug Utilization Review
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - *Heparin
MH  - Heparin, Low-Molecular-Weight
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/complications/drug therapy/mortality
MH  - Registries
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2003/09/06 05:00
MHDA- 2004/05/22 05:00
CRDT- 2003/09/06 05:00
PHST- 2003/09/06 05:00 [pubmed]
PHST- 2004/05/22 05:00 [medline]
PHST- 2003/09/06 05:00 [entrez]
AID - 03090519 [pii]
AID - 10.1160/TH02-12-0315 [doi]
PST - ppublish
SO  - Thromb Haemost. 2003 Sep;90(3):519-27. doi: 10.1160/TH02-12-0315.