PMID- 17161049
OWN - NLM
STAT- MEDLINE
DCOM- 20070108
LR  - 20220318
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 152
IP  - 6
DP  - 2006 Dec
TI  - Efficacy and safety of enoxaparin compared with unfractionated heparin in 
      high-risk patients with non-ST-segment elevation acute coronary syndrome 
      undergoing percutaneous coronary intervention in the Superior Yield of the New 
      Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors 
      (SYNERGY) trial.
PG  - 1042-50
AB  - BACKGROUND: Enoxaparin reduces ischemic events more effectively than 
      unfractionated heparin (UFH) in patients treated conservatively for 
      non-ST-segment elevation acute coronary syndrome. The SYNERGY trial compared 
      these agents in high-risk patients undergoing early invasive treatment. 
      Enoxaparin was noninferior to UFH for the 30-day primary end point of 
      death/myocardial infarction (MI), but modestly increased bleeding. METHODS AND 
      RESULTS: This article compares the outcomes of the 4687 SYNERGY patients (47%) 
      undergoing percutaneous coronary intervention, who were randomized to receive 
      enoxaparin or UFH. Antithrombotic therapy was administered prerandomization in 
      78%. Crossover (usually in the catheterization laboratory) to the alternative 
      antithrombotic occurred in 14.6% of enoxaparin patients and 2.9% of UFH-treated 
      patients (P < .0001). Stenting was performed in 86.3%. Abrupt vessel closure 
      occurred in 1.3% of enoxaparin patients and 1.7% of UFH-treated patients (P = 
      .318). The rates of death/MI were similar at 30 days (13.1% with enoxaparin vs 
      14.2% with UFH, P = .289). GUSTO severe bleeding occurred with similar frequency 
      in both groups (1.5% vs 1.6%, P = .688). TIMI major bleeding was more common with 
      enoxaparin (3.7% vs 2.5% with UFH, P = .028). Transfusions were more frequent 
      with enoxaparin than with UFH (6.8% vs 5.4%, P = .047). TIMI major bleeding 
      increased with crossover from enoxaparin to UFH (from 3.7% to 7.8%) and from UFH 
      to enoxaparin (from 2.5% to 8.6%). Statistical adjustment to model reasons for 
      crossover did not affect the overall safety and efficacy outcomes. CONCLUSIONS: 
      In high-risk patients undergoing early percutaneous coronary intervention for 
      acute coronary syndrome, enoxaparin avoids the need for monitoring and achieves 
      similar effectiveness to UFH but is associated with more bleeding.
FAU - White, Harvey D
AU  - White HD
AD  - Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. 
      harveyw@adhb.govt.nz
FAU - Kleiman, Neal S
AU  - Kleiman NS
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
FAU - Lokhnygina, Yuliya
AU  - Lokhnygina Y
FAU - Pieper, Karen S
AU  - Pieper KS
FAU - Chiswell, Karen
AU  - Chiswell K
FAU - Cohen, Marc
AU  - Cohen M
FAU - Harrington, Robert A
AU  - Harrington RA
FAU - Chew, Derek P
AU  - Chew DP
FAU - Petersen, John L
AU  - Petersen JL
FAU - Berdan, Lisa G
AU  - Berdan LG
FAU - Aylward, Philip E G
AU  - Aylward PE
FAU - Nessel, Christopher C
AU  - Nessel CC
FAU - Ferguson, James J 3rd
AU  - Ferguson JJ 3rd
FAU - Califf, Robert M
AU  - Califf RM
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
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)
SB  - IM
EIN - Am Heart J. 2007 Feb;153(2):327
MH  - Acute Disease
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Blood Transfusion
MH  - Coronary Disease/*therapy
MH  - Cross-Over Studies
MH  - Enoxaparin/adverse effects/*therapeutic use
MH  - Female
MH  - Hemorrhage/chemically induced/therapy
MH  - Heparin/adverse effects/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - Risk Factors
MH  - Syndrome
MH  - Treatment Outcome
EDAT- 2006/12/13 09:00
MHDA- 2007/01/09 09:00
CRDT- 2006/12/13 09:00
PHST- 2006/04/11 00:00 [received]
PHST- 2006/08/02 00:00 [accepted]
PHST- 2006/12/13 09:00 [pubmed]
PHST- 2007/01/09 09:00 [medline]
PHST- 2006/12/13 09:00 [entrez]
AID - S0002-8703(06)00718-6 [pii]
AID - 10.1016/j.ahj.2006.08.002 [doi]
PST - ppublish
SO  - Am Heart J. 2006 Dec;152(6):1042-50. doi: 10.1016/j.ahj.2006.08.002.