PMID- 24972265
OWN - NLM
STAT- MEDLINE
DCOM- 20151002
LR  - 20230607
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 2014
IP  - 6
DP  - 2014 Jun 27
TI  - Heparin versus placebo for non-ST elevation acute coronary syndromes.
PG  - CD003462
LID - 10.1002/14651858.CD003462.pub3 [doi]
LID - CD003462
AB  - BACKGROUND: Non-ST elevation acute coronary syndromes (NSTEACS) represent a 
      spectrum of disease including unstable angina and non-ST segment myocardial 
      infarction (NSTEMI). Despite treatment with aspirin, beta-blockers and 
      nitroglycerin, unstable angina/NSTEMI is still associated with significant 
      morbidity and mortality. Although evidence suggests that low molecular weight 
      heparin (LMWH) is more efficacious compared to unfractionated heparin (UFH), 
      there is limited data to support the role of heparins as a drug class in the 
      treatment of NSTEACS. This is an update of a review last published in 2008. 
      OBJECTIVES: To determine the effect of heparins (UFH and LMWH) compared with 
      placebo for the treatment of patients with non-ST elevation acute coronary 
      syndromes (unstable angina or NSTEMI). SEARCH METHODS: For this update the 
      Cochrane Heart Group Trials Search Co-ordinator searched the Cochrane Central 
      Register of Controlled Trials on The Cochrane Library (2013, Issue 12), MEDLINE 
      (OVID, 1946 to January week 1 2014), EMBASE (OVID, 1947 to 2014 week 02), CINAHL 
      (1937 to 15 January 2014) and LILACS (1982 to 15 January 2014). We applied no 
      language restrictions. SELECTION CRITERIA: Randomized controlled trials of 
      parenteral UFH or LMWH versus placebo in people with non-ST elevation acute 
      coronary syndromes (unstable angina or NSTEMI). DATA COLLECTION AND ANALYSIS: Two 
      review authors independently assessed quality of studies and independently 
      extracted data. MAIN RESULTS: There were no new included studies for this update. 
      Eight studies (3118 participants) were included in this review. We found no 
      evidence for difference in overall mortality between the groups treated with 
      heparin and placebo (risk ratio (RR) = 0.84, 95% confidence interval (CI) 0.36 to 
      1.98). Heparins compared with placebo, reduced the occurrence of myocardial 
      infarction in patients with unstable angina and NSTEMI (RR = 0.40, 95% CI 0.25 to 
      0.63, number needed to benefit (NNTB) = 33). There was a trend towards more major 
      bleeds in the heparin studies compared to control studies (RR = 2.05, 95% CI 0.91 
      to 4.60). From a limited data set, there appeared to be no difference between 
      patients treated with heparins compared to control in the occurrence of 
      thrombocytopenia (RR = 0.20, 95% CI 0.01 to 4.24). Assessment of overall risk of 
      bias in these studies was limited as most of the studies did not give sufficient 
      detail to allow assessment of potential risk of bias. AUTHORS' CONCLUSIONS: 
      Compared with placebo, patients treated with heparins had a similar risk of 
      mortality, revascularization, recurrent angina, and thrombocytopenia. However, 
      those treated with heparins had a decreased risk of myocardial infarction and a 
      higher incidence of minor bleeding. Overall, the evidence assessed in this review 
      was classified as low quality according to the GRADE approach. The results 
      presented in this review must therefore be interpreted with caution.
FAU - Andrade-Castellanos, Carlos A
AU  - Andrade-Castellanos CA
AD  - Department of Internal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. 
      Menchaca", Salvador Quevedo y Zubieta No. 750, Guadalajara, Jalisco, Mexico, 
      44340.
FAU - Colunga-Lozano, Luis E
AU  - Colunga-Lozano LE
FAU - Delgado-Figueroa, Netzahualpilli
AU  - Delgado-Figueroa N
FAU - Magee, Kirk
AU  - Magee K
LA  - eng
GR  - Canadian Institutes of Health Research/Canada
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20140627
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Placebos)
RN  - 9005-49-6 (Heparin)
SB  - IM
UOF - Cochrane Database Syst Rev. 2008;(2):CD003462. PMID: 18425889
MH  - Acute Coronary Syndrome/*drug therapy/mortality
MH  - Angina, Unstable/drug therapy
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Heparin/adverse effects/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Myocardial Infarction/prevention & control
MH  - Placebos/therapeutic use
MH  - Randomized Controlled Trials as Topic
PMC - PMC6769062
COIS- The authors who have been involved in this review have done so without any known 
      conflicts of interest.
EDAT- 2014/06/28 06:00
MHDA- 2015/10/03 06:00
PMCR- 2015/06/27
CRDT- 2014/06/28 06:00
PHST- 2014/06/28 06:00 [entrez]
PHST- 2014/06/28 06:00 [pubmed]
PHST- 2015/10/03 06:00 [medline]
PHST- 2015/06/27 00:00 [pmc-release]
AID - CD003462.pub3 [pii]
AID - 10.1002/14651858.CD003462.pub3 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2014 Jun 27;2014(6):CD003462. doi: 
      10.1002/14651858.CD003462.pub3.