Document Detail

Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial.
MedLine Citation:
PMID:  10517729     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Low-molecular-weight heparins are attractive alternatives to unfractionated heparin (UFH) for management of unstable angina/non-Q-wave myocardial infarction (UA/NQMI). METHODS AND RESULTS: Patients (n=3910) with UA/NQMI were randomized to intravenous UFH for >/=3 days followed by subcutaneous placebo injections or uninterrupted antithrombin therapy with enoxaparin during both the acute phase (initial 30 mg intravenous bolus followed by injections of 1.0 mg/kg every 12 hours) and outpatient phase (injections every 12 hours of 40 mg for patients weighing <65 kg and 60 mg for those weighing >/=65 kg). The primary end point (death, myocardial infarction, or urgent revascularization) occurred by 8 days in 14.5% of patients in the UFH group and 12.4% of patients in the enoxaparin group (OR 0.83; 95% CI 0.69 to 1.00; P=0. 048) and by 43 days in 19.7% of the UFH group and 17.3% of the enoxaparin group (OR 0.85; 95% CI 0.72 to 1.00; P=0.048). During the first 72 hours and also throughout the entire initial hospitalization, there was no difference in the rate of major hemorrhage in the treatment groups. During the outpatient phase, major hemorrhage occurred in 1.5% of the group treated with placebo and 2.9% of the group treated with enoxaparin (P=0.021). CONCLUSIONS: Enoxaparin is superior to UFH for reducing a composite of death and serious cardiac ischemic events during the acute management of UA/NQMI patients without causing a significant increase in the rate of major hemorrhage. No further relative decrease in events occurred with outpatient enoxaparin treatment, but there was an increase in the rate of major hemorrhage.
E M Antman; C H McCabe; E P Gurfinkel; A G Turpie; P J Bernink; D Salein; A Bayes De Luna; K Fox; J M Lablanche; D Radley; J Premmereur; E Braunwald
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Publication Detail:
Type:  Clinical Trial; Clinical Trial, Phase III; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  100     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  1999 Oct 
Date Detail:
Created Date:  1999-11-04     Completed Date:  1999-11-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1593-601     Citation Subset:  AIM; IM    
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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MeSH Terms
Acute Disease
Angina, Unstable / complications,  drug therapy*,  surgery
Anticoagulants / administration & dosage,  adverse effects,  therapeutic use
Creatine Kinase / blood
Double-Blind Method
Enoxaparin / administration & dosage,  adverse effects,  therapeutic use*
Europe / epidemiology
Factor Xa / antagonists & inhibitors
Fibrinolytic Agents / administration & dosage,  adverse effects,  therapeutic use*
Hemorrhage / chemically induced
Heparin / administration & dosage,  adverse effects,  therapeutic use*
Life Tables
Middle Aged
Myocardial Infarction / drug therapy*,  epidemiology,  etiology,  prevention & control,  surgery
Myocardial Revascularization / statistics & numerical data
North America / epidemiology
Partial Thromboplastin Time
South America / epidemiology
Thrombolytic Therapy* / adverse effects
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 0/Enoxaparin; 0/Fibrinolytic Agents; 0/Isoenzymes; 9005-49-6/Heparin; EC Kinase; EC Xa
Comment In:
Circulation. 1999 Oct 12;100(15):1586-9   [PMID:  10517727 ]

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