PMID- 16124952
OWN - NLM
STAT- MEDLINE
DCOM- 20050915
LR  - 20131121
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 149
IP  - 4 Suppl
DP  - 2005 Apr
TI  - Exploring the role of enoxaparin in the management of high-risk patients with 
      non-ST-elevation acute coronary syndromes: the SYNERGY trial.
PG  - S81-90
AB  - BACKGROUND: In patients with non-ST-elevation acute coronary syndromes (NSTE 
      ACS), enoxaparin has been shown to be superior to unfractionated heparin (UFH) 
      and is associated with a reduction in ischemic end points with nonsignificant 
      increases in bleeding. However, the critical trials comparing enoxaparin with UFH 
      were conducted before the widespread use of early invasive management and the 
      availability of clopidogrel and glycoprotein IIb/IIIa receptor antagonists. 
      METHODS: SYNERGY was an international, multicenter, randomized, open-label trial 
      that compared enoxaparin with UFH in high-risk NSTE ACS patients managed with an 
      early invasive strategy. For enrollment, 2 out of 3 high-risk features were 
      required: age > or =60 years, elevated cardiac biomarkers, or ST-segment changes. 
      The primary efficacy end point was death/myocardial infarction (MI) at 30 days. 
      The primary safety end point was inhospital major bleeding or stroke through 30 
      days. RESULTS: The incidence of death/MI at 30 days was 14.0% in the enoxaparin 
      group and 14.5% in the UFH group (hazard ratio 0.96, 95% CI 0.86-1.06), 
      demonstrating noninferiority of enoxaparin relative to UFH. Enoxaparin was 
      associated with a small but significant excess of Thrombolysis In Myocardial 
      Infarction (TIMI) major bleeding, but there was no statistically significant 
      increase in Global Utilization of Streptokinase and t-PA for Occluded Coronary 
      Arteries (GUSTO) severe bleeding or the rate of transfusion. There was no 
      difference in complications of percutaneous coronary intervention. Interpretation 
      of trial results was complicated by widespread use of enoxaparin or UFH before 
      randomization, and by postrandomization crossover to the nonrandomized agent. 
      CONCLUSIONS: In patients with NSTE ACS, including high-risk patients proceeding 
      rapidly to catheterization, enoxaparin is an effective and safe alternative to 
      UFH.
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
AD  - Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 
      USA.
FAU - Ferguson, James J
AU  - Ferguson JJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 9005-49-6 (Heparin)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
CIN - Evid Based Cardiovasc Med. 2005 Sep;9(3):180-3. PMID: 16380024
MH  - Aged
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Aspirin/therapeutic use
MH  - Cardiac Catheterization
MH  - Enoxaparin/adverse effects/*therapeutic use
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multicenter Studies as Topic
MH  - Myocardial Infarction/mortality/*prevention & control
MH  - Myocardial Ischemia/drug therapy
MH  - Myocardial Revascularization
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - Randomized Controlled Trials as Topic
MH  - Syndrome
EDAT- 2005/08/30 09:00
MHDA- 2005/09/16 09:00
CRDT- 2005/08/30 09:00
PHST- 2005/08/30 09:00 [pubmed]
PHST- 2005/09/16 09:00 [medline]
PHST- 2005/08/30 09:00 [entrez]
AID - S0002-8703(05)00202-4 [pii]
AID - 10.1016/j.ahj.2005.02.023 [doi]
PST - ppublish
SO  - Am Heart J. 2005 Apr;149(4 Suppl):S81-90. doi: 10.1016/j.ahj.2005.02.023.