PMID- 16124953
OWN - NLM
STAT- MEDLINE
DCOM- 20050915
LR  - 20071115
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 149
IP  - 4 Suppl
DP  - 2005 Apr
TI  - A perspective on trials comparing enoxaparin and unfractionated heparin in the 
      treatment of non-ST-elevation acute coronary syndromes.
PG  - S91-9
AB  - BACKGROUND: Non-ST-elevation (NSTE) acute coronary syndrome (ACS) is a serious, 
      acute illness characterized by a high rate of death and morbid events, and 
      antithrombin therapy is integral to its management. Contemporary guidelines from 
      the American College of Cardiology/American Heart Association call for use of 
      low-molecular-weight heparin or unfractionated heparin (UFH). METHODS: A 
      systematic overview of six randomized, controlled trials comparing enoxaparin to 
      UFH in the treatment of NSTE ACS was performed using a random-effects empirical 
      Bayes model. Efficacy end points included the incidence of death or the composite 
      of death and myocardial infarction (MI) at 30 days. Safety end points included 
      major bleeding and transfusion at 7 days. RESULTS: For the aggregate of 21,946 
      patients, the incidence of the composite of death and MI at 30 days was lower in 
      enoxaparin-treated patients (10.1% vs 11.0% for UFH, OR 0.91, 95% CI 0.83-0.99, 
      number need to treat 107). For the 9,835 patients in these trials who received no 
      prerandomization antithrombin therapy, the composite of death and MI at 30 days 
      occurred in 8.0% and 9.4% of enoxaparin- and UFH-treated patients, respectively 
      (OR 0.81, 95% CI 0.70-0.94, number need to treat 94). There was no significant 
      difference in the incidence of death at 30 days in either population. A 
      nonsignificant trend toward higher rates of major bleeding was seen at 7 days for 
      enoxaparin-treated patients, in both the overall safety population and the 
      population of patients who did not receive antithrombin treatment before 
      randomization, but there was no difference in blood transfusions. CONCLUSION: In 
      a systematic overview of six randomized, controlled trials comparing enoxaparin 
      to UFH in the treatment of NSTE ACS in approximately 22,000 patients, the use of 
      enoxaparin rather than UFH was associated with a modest reduction in the 
      incidence of the composite of death and MI at 30 days without a significant 
      increase in the rate of major bleeding or transfusion at 7 days.
FAU - Califf, Robert M
AU  - Califf RM
AD  - Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 
      27705, USA. calif001@mc.duke.edu
FAU - Petersen, John L
AU  - Petersen JL
FAU - Hasselblad, Vic
AU  - Hasselblad V
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
FAU - Ferguson, James J
AU  - Ferguson JJ
LA  - eng
PT  - Journal Article
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)
SB  - IM
MH  - Aged
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Coronary Disease/*complications
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  - Myocardial Infarction/mortality/*prevention & control
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)00182-1 [pii]
AID - 10.1016/j.ahj.2005.02.021 [doi]
PST - ppublish
SO  - Am Heart J. 2005 Apr;149(4 Suppl):S91-9. doi: 10.1016/j.ahj.2005.02.021.