PMID- 17600038
OWN - NLM
STAT- MEDLINE
DCOM- 20080617
LR  - 20220318
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 28
IP  - 17
DP  - 2007 Sep
TI  - Efficacy and safety of the low-molecular weight heparin enoxaparin compared with 
      unfractionated heparin across the acute coronary syndrome spectrum: a 
      meta-analysis.
PG  - 2077-86
AB  - AIMS: To determine whether the low-molecular weight heparin enoxaparin remains 
      favourable when compared with unfractionated heparin (UFH) among patients with 
      acute coronary syndromes (ACS) when incorporating efficacy and safety of these 
      adjunctive therapies using a net clinical endpoint. METHODS AND RESULTS: We 
      performed a meta-analysis of randomized trials of enoxaparin vs. UFH in 
      ST-elevation-MI (STEMI) or non-ST-elevation-ACS (NSTEACS) (n = 49,088 patients in 
      12 trials). The net clinical endpoint was defined as death, MI, or major bleeding 
      by 30 days. Death or myocardial infarction (MI) was significantly reduced with 
      enoxaparin when compared with UFH (9.8 vs. 11.4%, OR 0.84, P < 0.001). The net 
      clinical endpoint occurred less frequently with enoxaparin than UFH (12.5 vs. 
      13.5%, OR 0.90, P = 0.051). Major bleeding was higher with enoxaparin (4.3 vs. 
      3.4%, OR 1.25, P = 0.019). Among STEMI trials, the net clinical endpoint was 
      significantly lower with enoxaparin (OR 0.84, P = 0.015), but there was no 
      difference in NSTEACS trials (OR 0.97). CONCLUSIONS: When compared with UFH, 
      enoxaparin was associated with superior efficacy as adjunctive antithrombin 
      therapy among >49 000 patients across the ACS spectrum. Although bleeding was 
      increased with enoxaparin, this increase was offset by a reduction in death or 
      MI. The net clinical benefit in favour of enoxaparin was evident among the STEMI 
      population and was neutral among the NSTEACS population.
FAU - Murphy, Sabina A
AU  - Murphy SA
AD  - TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and 
      Women's Hospital and Harvard Medical School, 350 Longwood Avenue, First Floor, 
      Boston, MA 02115, USA. smurphy@perfuse.org
FAU - Gibson, Charles Michael
AU  - Gibson CM
FAU - Morrow, David A
AU  - Morrow DA
FAU - Van de Werf, Frans
AU  - Van de Werf F
FAU - Menown, Ian B
AU  - Menown IB
FAU - Goodman, Shaun G
AU  - Goodman SG
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
FAU - Cohen, Marc
AU  - Cohen M
FAU - McCabe, Carolyn H
AU  - McCabe CH
FAU - Antman, Elliott M
AU  - Antman EM
FAU - Braunwald, Eugene
AU  - Braunwald E
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20070628
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Antithrombins)
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Antithrombins/*therapeutic use
MH  - Double-Blind Method
MH  - Drug Therapy, Combination
MH  - Enoxaparin/*therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Secondary Prevention
MH  - Treatment Outcome
RF  - 31
EDAT- 2007/06/30 09:00
MHDA- 2008/06/18 09:00
CRDT- 2007/06/30 09:00
PHST- 2007/06/30 09:00 [pubmed]
PHST- 2008/06/18 09:00 [medline]
PHST- 2007/06/30 09:00 [entrez]
AID - ehm224 [pii]
AID - 10.1093/eurheartj/ehm224 [doi]
PST - ppublish
SO  - Eur Heart J. 2007 Sep;28(17):2077-86. doi: 10.1093/eurheartj/ehm224. Epub 2007 
      Jun 28.