PMID- 16683212
OWN - NLM
STAT- MEDLINE
DCOM- 20060811
LR  - 20211020
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 21
IP  - 3
DP  - 2006 Jun
TI  - Low-molecular-weight heparin compared with unfractionated heparin for patients 
      with non-ST-segment elevation acute coronary syndromes treated with glycoprotein 
      IIb/IIIa inhibitors: results from the CRUSADE initiative.
PG  - 211-20
AB  - BACKGROUND: Both heparin and glycoprotein (GP) IIb/IIIa inhibitor therapy and 
      early invasive management strategies are recommended by the American College of 
      Cardiology (ACC)/American Heart Association (AHA) guidelines for the treatment of 
      patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). 
      However, controversy exists about which form of heparin-unfractionated (UF) or 
      low-molecular-weight (LMW)-is preferable. We sought to compare the efficacy and 
      safety of these treatment strategies in a large contemporary population of 
      patients with NSTE ACS. METHODS: Using data from the CRUSADE Initiative, we 
      evaluated LMWH and UFH in high-risk NSTE ACS patients (positive cardiac markers 
      and/or ischemic ST-segment changes) who had received early (< 24 hours) GP 
      IIb/IIIa inhibitor therapy and underwent early invasive management. In-hospital 
      outcomes were compared among treatment groups. RESULTS: From a total of 11,358 
      patients treated at 407 hospitals in the US from January 2002-June 2003, 6881 
      (60.6%) received UFH and 4477 (39.4%) received LMWH. Patients treated with UFH 
      were more often admitted to a cardiology inpatient service (73.6% vs. 65.5%, P < 
      0.0001) and more frequently underwent diagnostic catheterization (91.8% vs. 
      85.9%, P < 0.0001) and percutaneous coronary intervention (PCI) (69.7% vs. 56.9%, 
      P < 0.0001) than patients treated with LMWH. The point estimate of the adjusted 
      risk of in-hospital death or reinfarction was slightly lower among patients 
      treated with LMWH (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.67-0.99) 
      and the risk of red blood cell transfusion was similar (OR 1.01, 95% CI 
      0.89-1.15). Among patients who underwent PCI within 48 hours, adjusted rates of 
      death (OR 1.14, 95% CI 0.71-1.85), death or reinfarction (OR 0.93, 0.67-1.31), 
      and transfusion (OR 1.16, 0.89-1.50) were similar. Patients who underwent PCI 
      more than 48 hours into hospitalization had reduced rates of death (OR 0.64, 
      0.46-0.88), death or reinfarction (OR 0.57, 0.44-0.73), and transfusion (OR 0.66, 
      0.52-0.84). CONCLUSIONS: In routine clinical practice, patients treated with GP 
      IIb/IIIa inhibitors have slightly improved outcomes and similar bleeding risks 
      with LMWH than with UFH. These findings are consistent with current ACC/AHA 
      guidelines but raise important questions about the safety and effectiveness of 
      antithrombotic therapy in real-world clinical practice. Using data from the 
      CRUSADE Initiative, we evaluated low-molecular-weight heparin (LMWH) and 
      unfractionated heparin (UFH) in high-risk patients with non-ST-segment elevation 
      acute coronary syndromes (NSTE ACS) who received early (<24 hours) glycoprotein 
      (GP) IIb/IIIa inhibitors and early invasive management. In-hospital outcomes were 
      compared among treatment groups. LMWH was associated with slightly improved 
      clinical outcomes and similar rates of transfusion compared with UFH. Our results 
      support the current ACC/AHA guidelines recommendations but raise concerns about 
      the safety and efficacy of UFH in the setting of background use of upstream GP 
      IIb/IIIa inhibitors for patients with NSTE ACS in routine clinical practice.
FAU - Singh, Kanwar P
AU  - Singh KP
AD  - Division of Cardiology and Duke Clinical Research Institute, Durham, NC 27705, 
      USA.
FAU - Roe, Matthew T
AU  - Roe MT
FAU - Peterson, Eric D
AU  - Peterson ED
FAU - Chen, Anita Y
AU  - Chen AY
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
FAU - Goodman, Shaun G
AU  - Goodman SG
FAU - Harrington, Robert A
AU  - Harrington RA
FAU - Smith, Sidney C Jr
AU  - Smith SC Jr
FAU - Gibler, W Brian
AU  - Gibler WB
FAU - Ohman, E Magnus
AU  - Ohman EM
FAU - Pollack, Charles V Jr
AU  - Pollack CV Jr
CN  - CRUSADE Investigators
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - Female
MH  - Health Status
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/*drug therapy
MH  - Myocardial Revascularization
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - Treatment Outcome
EDAT- 2006/05/10 09:00
MHDA- 2006/08/12 09:00
CRDT- 2006/05/10 09:00
PHST- 2006/05/10 09:00 [pubmed]
PHST- 2006/08/12 09:00 [medline]
PHST- 2006/05/10 09:00 [entrez]
AID - 10.1007/s11239-006-5708-0 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2006 Jun;21(3):211-20. doi: 10.1007/s11239-006-5708-0.