PMID- 17540196
OWN - NLM
STAT- MEDLINE
DCOM- 20070614
LR  - 20131121
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 153
IP  - 6
DP  - 2007 Jun
TI  - Interactions between heparins, glycoprotein IIb/IIIa antagonists, and coronary 
      intervention. The Global Registry of Acute Coronary Events (GRACE).
PG  - 960-9
AB  - OBJECTIVES: The purpose of this study is to evaluate hospital mortality and major 
      bleeding rates among patients receiving low molecular weight heparin (LMWH), 
      unfractionated heparin (UFH), or both, and to investigate whether concomitant 
      glycoprotein (GP) IIb/IIIa antagonists and coronary intervention affect patterns 
      of use and outcomes with different heparins. BACKGROUND: With widespread use of 
      glycoprotein (GP) IIb/IIIa inhibitors and invasive treatments, patients with 
      high-risk acute coronary syndrome (ACS) may have a greater bleeding risk and may 
      not gain additional benefit from LMWHs. The purpose of this study is to evaluate 
      hospital mortality and major bleeding rates among patients receiving LMWH, UFH, 
      or both, and to investigate whether concomitant GP IIb/IIIa antagonists and 
      coronary intervention affect patterns of use and outcomes with different 
      heparins. METHODS: Data were analyzed from 28,445 patients with ACS; 21,287 had 
      non-ST-segment elevation myocardial infarction or unstable angina and received 
      LMWH or UFH. RESULTS: Fifty-one percent of patients received LMWH, 32% UFH, and 
      17% both. The lowest inhospital mortality and bleeding rates occurred with LMWH 
      (2.7% and 1.8% vs UFH, 4.1% and 2.7%; all P < .0001). After multivariable 
      analysis, LMWH was associated with lower inhospital mortality rates in patients 
      not treated with GP IIb/IIIa antagonists, irrespective of whether they had a 
      percutaneous coronary intervention (PCI) (odds ratio 0.77, 95% confidence 
      interval 0.63-0.94 without PCI vs odds ratio 0.45, 95% confidence interval 
      0.21-0.98 with PCI). Excess bleeding occurred with PCI in LMWH-treated patients. 
      Patients older than 75 years who received GP IIb/IIIa antagonists and any 
      antithrombotic but not PCI had an increased risk of major bleeding (LMWH 14%, UFH 
      8.3%). CONCLUSIONS: In patients with non-ST-elevation ACS without GP IIb/IIIa 
      antagonists, LMWH was associated with a lower mortality rate and more bleeding 
      episodes in PCI-treated patients than UFH; no differences occurred with GP 
      IIb/IIIa antagonists. Elderly patients managed medically with GP IIb/IIIa 
      antagonists and either heparin had a very high major bleeding risk.
FAU - Brieger, David
AU  - Brieger D
AD  - Concord Hospital, Sydney, Australia. davidb@email.cs.nsw.gov.au
FAU - Van de Werf, Frans
AU  - Van de Werf F
FAU - Avezum, Alvaro
AU  - Avezum A
FAU - Montalescot, Gilles
AU  - Montalescot G
FAU - Kennelly, Brian M
AU  - Kennelly BM
FAU - Granger, Christopher B
AU  - Granger CB
FAU - Goodman, Shaun G
AU  - Goodman SG
FAU - Dabbous, Omar H
AU  - Dabbous OH
FAU - Agnelli, Giancarlo
AU  - Agnelli G
CN  - GRACE Investigators
LA  - eng
PT  - Comparative Study
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 (Heparin, Low-Molecular-Weight)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/statistics & numerical data
MH  - Comorbidity
MH  - Coronary Disease/epidemiology/*therapy
MH  - Drug Interactions
MH  - Female
MH  - Hemorrhage/*chemically induced/*epidemiology
MH  - Heparin/*adverse effects/analogs & derivatives
MH  - Heparin, Low-Molecular-Weight/adverse effects
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - *Registries
MH  - Risk Assessment
MH  - Survival Analysis
MH  - Survival Rate
MH  - Warfarin/administration & dosage
EDAT- 2007/06/02 09:00
MHDA- 2007/06/15 09:00
CRDT- 2007/06/02 09:00
PHST- 2006/11/27 00:00 [received]
PHST- 2007/03/09 00:00 [accepted]
PHST- 2007/06/02 09:00 [pubmed]
PHST- 2007/06/15 09:00 [medline]
PHST- 2007/06/02 09:00 [entrez]
AID - S0002-8703(07)00259-1 [pii]
AID - 10.1016/j.ahj.2007.03.035 [doi]
PST - ppublish
SO  - Am Heart J. 2007 Jun;153(6):960-9. doi: 10.1016/j.ahj.2007.03.035.