PMID- 15932908
OWN - NLM
STAT- MEDLINE
DCOM- 20060512
LR  - 20071115
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 26
IP  - 21
DP  - 2005 Nov
TI  - Non-ST-segment elevation acute coronary syndrome in patients with renal 
      dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein 
      IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events.
PG  - 2285-93
AB  - AIMS: To determine whether low-molecular-weight heparin (LMWH)+glycoprotein (GP) 
      IIb/IIIa inhibitors provide greater benefit than unfractionated heparin (UFH)+GP 
      IIb/IIIa inhibitors, irrespective of renal status. METHODS AND RESULTS: Patients 
      in the Global Registry of Acute Coronary Events (GRACE) were divided into three 
      groups according to creatinine clearance (CrCl): normal renal function (CrCl >60 
      mL/min), moderate renal dysfunction (30<CrCl< or =60 mL/min), and severe (CrCl< 
      or =30 mL/min) renal dysfunction. Data were analysed from 11 881 patients with 
      acute coronary syndrome (ACS). Patients with moderate (n=3705) or severe (n=982) 
      renal dysfunction were at higher risk of adverse outcomes than those with normal 
      renal function. Decreasing CrCl was an independent predictor of mortality at 30 
      days and in-hospital major bleeding. LMWH+GP IIb/IIIa inhibitors were used 
      significantly less frequently in patients with severe (2.0%) or moderate (3.1%) 
      renal dysfunction than in those with normal function (3.9%, P=0.0056). LMWH alone 
      was more beneficial than UFH alone, irrespective of renal status. LMWH alone was 
      an independent predictor of 30 day survival [odds ratio (OR) 0.56; 95% confidence 
      interval (CI) 0.43-0.73] and lower risk of in-hospital bleeding (OR 0.66; 95% CI 
      0.48-0.92). Bleeding rates were significantly lower with LMWH+GP IIb/IIIa 
      inhibitors than those with UFH+GP IIb/IIIa inhibitors. Use of UFH+GP IIb/IIIa 
      inhibitors was an independent predictor of bleeding (OR 2.02; 95% CI 1.42-2.90) 
      compared with UFH alone. CONCLUSION: In patients with renal dysfunction and 
      non-ST-segment elevation ACS, bleeding complications are more frequent and 
      outcomes appear worse in individuals treated with UFH compared with LMWH. 
      Combination therapy with LMWH and GP IIb/IIIa inhibitors appears to be better 
      tolerated than with UFH and GP IIb/IIIa inhibitors.
FAU - Collet, Jean-Philippe
AU  - Collet JP
AD  - Department of Cardiology, Centre Hopital Pitie-Salpetriere, Bureau 2-236, 47, 
      Boulevard de l'Hopital, 75013 Paris, France.
FAU - Montalescot, Gilles
AU  - Montalescot G
FAU - Agnelli, Giancarlo
AU  - Agnelli G
FAU - Van de Werf, Frans
AU  - Van de Werf F
FAU - Gurfinkel, Enrique P
AU  - Gurfinkel EP
FAU - Lopez-Sendon, Jose
AU  - Lopez-Sendon J
FAU - Laufenberg, Christopher V
AU  - Laufenberg CV
FAU - Klutman, Martin
AU  - Klutman M
FAU - Gowda, Neelam
AU  - Gowda N
FAU - Gulba, Dietrich
AU  - Gulba D
CN  - GRACE Investigators
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20050602
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
SB  - IM
MH  - Acute Disease
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - Coronary Disease/*drug therapy/mortality
MH  - Drug Therapy, Combination
MH  - Female
MH  - Hemorrhage/etiology/mortality
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Kidney Diseases/*complications/mortality
MH  - Male
MH  - Middle Aged
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*therapeutic use
MH  - Prospective Studies
MH  - Statistics as Topic
MH  - Syndrome
MH  - Treatment Outcome
EDAT- 2005/06/04 09:00
MHDA- 2006/05/13 09:00
CRDT- 2005/06/04 09:00
PHST- 2005/06/04 09:00 [pubmed]
PHST- 2006/05/13 09:00 [medline]
PHST- 2005/06/04 09:00 [entrez]
AID - ehi337 [pii]
AID - 10.1093/eurheartj/ehi337 [doi]
PST - ppublish
SO  - Eur Heart J. 2005 Nov;26(21):2285-93. doi: 10.1093/eurheartj/ehi337. Epub 2005 
      Jun 2.