PMID- 32578166
OWN - NLM
STAT- MEDLINE
DCOM- 20211005
LR  - 20211005
IS  - 1179-187X (Electronic)
IS  - 1175-3277 (Linking)
VI  - 21
IP  - 1
DP  - 2021 Jan
TI  - Comparative Effectiveness and Costs of Enoxaparin Monotherapy Versus 
      Unfractionated Heparin Monotherapy in Treating Acute Coronary Syndrome.
PG  - 93-101
LID - 10.1007/s40256-020-00419-9 [doi]
AB  - BACKGROUND: Enoxaparin and unfractionated heparin (UFH) are guideline-recommended 
      anticoagulants for patients with acute coronary syndrome (ACS), including 
      unstable angina (UA) and myocardial infarction with (STEMI) or without ST-segment 
      elevation (NSTEMI). Prior efficacy and safety evidence are mainly from clinical 
      trials. Economic data are insufficient. This study examined the differences in 
      utilization, effectiveness, safety, and costs in treating ACS between enoxaparin 
      and UFH monotherapy using real-world data. METHODS: Using data from 859 US 
      hospitals, inpatients >/= 18 years of age with a diagnosis of an initial episode of 
      ACS between 2010 and 2016 were identified. Outcomes included 30-day risk of 
      non-fatal myocardial infarction (MI), recurrent angina, in-hospital mortality, 
      composite ischemic complication (having MI/recurrent angina/death), major 
      bleeding, and costs. Multivariable regression was used to compare outcomes 
      between enoxaparin and UFH monotherapy. RESULTS: Among 1,048,053 eligible 
      patients (UA: 219,259; NSTEMI: 582,134; STEMI: 246,660), the prevalence of 
      enoxaparin monotherapy was 12.0%, 13.9%, and 5.1%, and the prevalence of UFH 
      monotherapy was 45.1%, 43.1% and 59.8%, for UA, NSTEMI, and STEMI patients, 
      respectively. Enoxaparin was associated with a lower risk of ischemic 
      complications and death among NSTEMI, but not in UA or STEMI patients, and with a 
      lower risk of major bleeding in all patients. Cost savings per patient during 
      index admission and 30-day follow-up for enoxaparin over UFH was $2972 for UA, 
      $2475 for NSTEMI, and $3050 for STEMI. CONCLUSIONS: Enoxaparin was associated 
      with a lower risk of ischemic complications (including death), lower costs, and 
      better safety than UFH among NSTEMI patients. Improving upstream selection of 
      anticoagulants in appropriate populations may help optimize clinical outcomes and 
      costs.
FAU - Rosenthal, Ning
AU  - Rosenthal N
AUID- ORCID: 0000-0002-3404-3717
AD  - Premier Applied Sciences, Premier Healthcare Solutions Inc., 13034 Ballantyne 
      Corporate Place, Charlotte, NC, 28277, USA. ning_rosenthal@premierinc.com.
FAU - Xiao, Zhimin
AU  - Xiao Z
AD  - Sanofi US, Cambridge, MA, USA.
FAU - Kartashov, Alex
AU  - Kartashov A
AD  - Premier Applied Sciences, Premier Healthcare Solutions Inc., 13034 Ballantyne 
      Corporate Place, Charlotte, NC, 28277, USA.
FAU - Levorsen, Andree
AU  - Levorsen A
AD  - Sanofi Norway, Oslo, Norway.
FAU - Shah, Bimal R
AU  - Shah BR
AD  - Duke University School of Medicine, Livongo Health, Durham, NC, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - New Zealand
TA  - Am J Cardiovasc Drugs
JT  - American journal of cardiovascular drugs : drugs, devices, and other 
      interventions
JID - 100967755
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy/mortality
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/administration & dosage/adverse effects/economics/*therapeutic use
MH  - Comorbidity
MH  - Enoxaparin/administration & dosage/adverse effects/*economics/*therapeutic use
MH  - Female
MH  - Health Expenditures/statistics & numerical data
MH  - Health Resources/statistics & numerical data
MH  - Heparin/administration & dosage/adverse effects/*economics/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/drug therapy
EDAT- 2020/06/25 06:00
MHDA- 2021/10/06 06:00
CRDT- 2020/06/25 06:00
PHST- 2020/06/25 06:00 [pubmed]
PHST- 2021/10/06 06:00 [medline]
PHST- 2020/06/25 06:00 [entrez]
AID - 10.1007/s40256-020-00419-9 [pii]
AID - 10.1007/s40256-020-00419-9 [doi]
PST - ppublish
SO  - Am J Cardiovasc Drugs. 2021 Jan;21(1):93-101. doi: 10.1007/s40256-020-00419-9.