PMID- 18071163
OWN - NLM
STAT- MEDLINE
DCOM- 20080129
LR  - 20101118
IS  - 0003-9926 (Print)
IS  - 0003-9926 (Linking)
VI  - 167
IP  - 22
DP  - 2007 Dec 10
TI  - Intravenous low-molecular-weight heparins compared with unfractionated heparin in 
      percutaneous coronary intervention: quantitative review of randomized trials.
PG  - 2423-30
AB  - BACKGROUND: Despite its limitations, unfractionated heparin (UFH) is the 
      recommended anticoagulant during percutaneous coronary intervention (PCI). Few 
      randomized trials have compared low-molecular-weight heparin (LMWH) and UFH, and 
      most lacked the power to detect a difference between the 2 anticoagulants in 
      terms of safety or efficacy. Our objective was to perform a meta-analysis of 
      randomized trials comparing the efficacy and safety of LMWH vs UFH as 
      anticoagulants in the setting of PCI. METHODS: We used MEDLINE, randomized trials 
      presented at major cardiology conferences, and journal article bibliographies 
      from January 1998 and September 2006. Two reviewers independently identified 
      randomized studies comparing the intravenous administration of LMWH vs UFH among 
      patients undergoing PCI. Data on sample size, baseline characteristics, and 
      outcomes of interest were independently extracted and analyzed. RESULTS: Thirteen 
      trials including 7318 patients met the inclusion criteria. A total of 4201 
      patients (57.4%) received LMWH, and 3117 patients (42.6%) received UFH. 
      Intravenous LMWH use was associated with a significant reduction in the risk of 
      major bleeding compared with UFH (odds ratio [OR], 0.57; 95% confidence interval 
      [CI], 0.40-0.82; P = .002). A trend toward a reduction in minor bleeding was also 
      observed among LMWH-treated patients (OR, 0.75; 95% CI, 0.47-1.20; P = .24). 
      Similar efficacy was observed between LMWH and UFH regarding the double end point 
      of death or myocardial infarction (OR, 0.99; 95% CI, 0.79-1.24; P = .93). There 
      were no significant differences in death, myocardial infarction, and urgent 
      revascularization between patients receiving LMWH and those receiving UFH. 
      CONCLUSION: The use of intravenous LMWH during PCI is associated with a 
      significant reduction in major bleeding events compared with UFH, without 
      compromising outcomes on hard ischemic end points.
FAU - Dumaine, Raphaelle
AU  - Dumaine R
AD  - Centre Hospitalier Universitaire Pitie-Salpetriere, Institute of Cardiology, 
      Bureau 2-236, 47 Blvd de l'Hopital, 75013, Paris, France.
FAU - Borentain, Maria
AU  - Borentain M
FAU - Bertel, Osmund
AU  - Bertel O
FAU - Bode, Christoph
AU  - Bode C
FAU - Gallo, Richard
AU  - Gallo R
FAU - White, Harvey D
AU  - White HD
FAU - Collet, Jean-Philippe
AU  - Collet JP
FAU - Steinhubl, Steven R
AU  - Steinhubl SR
FAU - Montalescot, Gilles
AU  - Montalescot G
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Arch Intern Med
JT  - Archives of internal medicine
JID - 0372440
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 129480-74-6 (ITF 300)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Angioplasty, Balloon, Coronary/*methods
MH  - Anticoagulants/*administration & dosage
MH  - Heparin/administration & dosage/*analogs & derivatives
MH  - Heparin, Low-Molecular-Weight/*administration & dosage
MH  - Humans
MH  - Injections, Intravenous
MH  - Myocardial Ischemia/*therapy
MH  - Randomized Controlled Trials as Topic/*statistics & numerical data
MH  - Retrospective Studies
MH  - Treatment Outcome
RF  - 39
EDAT- 2007/12/12 09:00
MHDA- 2008/01/30 09:00
CRDT- 2007/12/12 09:00
PHST- 2007/12/12 09:00 [pubmed]
PHST- 2008/01/30 09:00 [medline]
PHST- 2007/12/12 09:00 [entrez]
AID - 167/22/2423 [pii]
AID - 10.1001/archinte.167.22.2423 [doi]
PST - ppublish
SO  - Arch Intern Med. 2007 Dec 10;167(22):2423-30. doi: 10.1001/archinte.167.22.2423.