PMID- 14680731
OWN - NLM
STAT- MEDLINE
DCOM- 20040108
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 42
IP  - 12
DP  - 2003 Dec 17
TI  - Recurrent cardiac ischemic events early after discontinuation of short-term 
      heparin treatment in acute coronary syndromes: results from the Thrombolysis in 
      Myocardial Infarction (TIMI) 11B and Efficacy and Safety of Subcutaneous 
      Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) studies.
PG  - 2083-9
AB  - OBJECTIVES: The aim of this study was to determine whether discontinuation of 
      low-molecular-weight heparin (LMWH) treatment results in a clustering of cardiac 
      ischemic events as previously observed after cessation of unfractionated heparin 
      (UFH) in acute coronary syndrome (ACS) patients. BACKGROUND: Clinical trials in 
      patients with ACS have shown early recurrent ischemic events after 
      discontinuation of UFH treatment. We analyzed whether LMWH cessation also results 
      in early ischemic recurrence events and if continuation of a fixed-dose LMWH 
      prevents this complication. METHODS: The combined incidence of death, myocardial 
      infarction, or urgent revascularization in the first seven days after 
      discontinuation of UFH (n = 3,012), short-term enoxaparin 1 mg/kg subcutaneously 
      twice a day (n = 2,011), and short-term enoxaparin followed by prolonged 
      enoxaparin 60 mg subcutaneously twice a day (n = 1,075) was analyzed from the 
      combined Thrombolysis In Myocardial Infarction (TIMI) 11B/Efficacy and Safety of 
      Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) database in a per 
      patient analysis. RESULTS: The cessation of both UFH and short-term enoxaparin 
      resulted in a similar clustering of recurrent ischemic events on the first day, 
      with an incidence of the primary end point of 2.8% in both groups. Of all 
      recurrent events in the first week after cessation, 40% occurred in the first 24 
      h. The continuation of a fixed-dose enoxaparin treatment prevented this early 
      excess, with a first day incidence of 0.4% (p < 0.0001). The TIMI risk score 
      characteristics predicted the incidence of early rebound ischemic events. 
      CONCLUSIONS: There is significant clustering of recurrent ischemic events within 
      24 h after cessation of both short-term UFH and enoxaparin treatment, and 
      patients should be carefully monitored during that period. This early rebound may 
      be prevented by continuation of a fixed dose of enoxaparin.
FAU - Bijsterveld, Nick R
AU  - Bijsterveld NR
AD  - Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
FAU - Peters, Ron J G
AU  - Peters RJ
FAU - Murphy, Sabina A
AU  - Murphy SA
FAU - Bernink, Peter J L M
AU  - Bernink PJ
FAU - Tijssen, Jan G P
AU  - Tijssen JG
FAU - Cohen, Marc
AU  - Cohen M
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Anticoagulants/*administration & dosage
MH  - Coronary Disease/*drug therapy
MH  - Drug Therapy, Combination
MH  - Enoxaparin/*administration & dosage
MH  - Heparin, Low-Molecular-Weight/*administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Recurrence
EDAT- 2003/12/19 05:00
MHDA- 2004/01/09 05:00
CRDT- 2003/12/19 05:00
PHST- 2003/12/19 05:00 [pubmed]
PHST- 2004/01/09 05:00 [medline]
PHST- 2003/12/19 05:00 [entrez]
AID - S073510970301307X [pii]
AID - 10.1016/j.jacc.2003.05.014 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2003 Dec 17;42(12):2083-9. doi: 10.1016/j.jacc.2003.05.014.