PMID- 19101783
OWN - NLM
STAT- MEDLINE
DCOM- 20091230
LR  - 20220419
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Linking)
VI  - 28
IP  - 3
DP  - 2009 Oct
TI  - Efficacy and safety of optimized antithrombotic therapy with aspirin, clopidogrel 
      and enoxaparin in patients with non-ST segment elevation acute coronary syndromes 
      in clinical practice.
PG  - 325-32
LID - 10.1007/s11239-008-0294-y [doi]
AB  - In randomized clinical trials enoxaparin in non ST-elevation acute coronary 
      syndromes (NSTE-ACS) has been shown to be more effective than unfractionated 
      heparin in preventing the combined endpoint of death and myocardial infarction. 
      Clopidogrel in combination with aspirin reduced the combined endpoint of death, 
      myocardial infarction and stroke in NSTE-ACS patients compared to aspirin alone. 
      Aim of the present study was to determine the clinical impact of optimized 
      antithrombotic therapy with enoxaparin, clopidogrel and aspirin compared to 
      standard therapy with unfractionated heparin (UFH) and aspirin in NSTE-ACS in 
      clinical practice. We analyzed data of 2,956 consecutive patients with NSTE-ACS 
      and either antithrombotic therapy with enoxaparin, clopidogrel and aspirin or 
      with aspirin and UFH, which were prospectively enrolled in the acute coronary 
      syndromes registry (ACOS) from July 2000 until the end of November 2002. After 
      adjustment for baseline characteristics and PCI the combined endpoint of hospital 
      death and non-fatal reinfarctions was lower in the group with optimized 
      antithrombotic therapy including clopidogrel, enoxaparin and aspirin compared to 
      the control-group with aspirin and UFH (odds ratio 0.30, 95% confidence interval 
      0.16-0.53). There was no significant difference in major bleedings between the 
      two treatment groups (1.5% vs. 0.9%, P = 0.35), while overall there were more 
      bleeding complications in the group with optimized antithrombotic therapy (4.9% 
      vs. 2.0%, P = 0.005). In clinical practice optimized antithrombotic therapy with 
      aspirin, clopidogrel and enoxaparin in NSTE-ACS is associated with a reduction in 
      the combined endpoint of death and non-fatal reinfarctions compared to standard 
      therapy with aspirin and UFH without increase in major bleeding complications.
FAU - Heer, Tobias
AU  - Heer T
AD  - Clinic Agatharied, Academic Teaching Hospital, University of Munich, 
      Norbert-Kerkel-Platz, Hausham, Germany. tobias.heer@khagatharied.de
FAU - Juenger, Claus
AU  - Juenger C
FAU - Gitt, Anselm K
AU  - Gitt AK
FAU - Bauer, Timm
AU  - Bauer T
FAU - Towae, Frank
AU  - Towae F
FAU - Zahn, Ralf
AU  - Zahn R
FAU - Senges, Jochen
AU  - Senges J
FAU - Zeymer, Uwe
AU  - Zeymer U
CN  - Acute Coronary Syndromes (ACOS) Registry Investigators
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20081220
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Acute Coronary Syndrome/complications/*drug therapy/mortality
MH  - Aged
MH  - Aspirin/*administration & dosage/adverse effects
MH  - Clopidogrel
MH  - Drug Evaluation
MH  - Drug Therapy, Combination
MH  - Drug-Related Side Effects and Adverse Reactions
MH  - Enoxaparin/*administration & dosage/adverse effects
MH  - Female
MH  - Fibrinolytic Agents/adverse effects/therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin/administration & dosage
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/adverse effects/therapeutic use
MH  - Registries
MH  - Retrospective Studies
MH  - Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives
MH  - Treatment Outcome
EDAT- 2008/12/23 09:00
MHDA- 2009/12/31 06:00
CRDT- 2008/12/23 09:00
PHST- 2008/07/04 00:00 [received]
PHST- 2008/11/03 00:00 [accepted]
PHST- 2008/12/23 09:00 [entrez]
PHST- 2008/12/23 09:00 [pubmed]
PHST- 2009/12/31 06:00 [medline]
AID - 10.1007/s11239-008-0294-y [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2009 Oct;28(3):325-32. doi: 10.1007/s11239-008-0294-y. 
      Epub 2008 Dec 20.