Document Detail


Low molecular weight heparins in the management of unstable angina/non-Q-wave myocardial infarction.
MedLine Citation:
PMID:  10549726     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The safety and efficacy of enoxaparin, dalteparin, and nadroparin have been studied in five major trials in the treatment of unstable angina/non-Q-wave myocardial infarction (UA/NQWMI). To date, enoxaparin is the only low molecular weight heparin (LMWH) to have demonstrated superiority over unfractionated heparin (UFH) in preventing clinical endpoints in this indication, including a composite triple endpoint of death, myocardial infarction, and need for revascularization. Equivalent clinical benefits were obtained with enoxaparin in two major phase III randomized trials (ESSENCE, TIMI 11B), and were not accompanied by any increased risk of major hemorrhage. A meta-analysis of data from TIMI 11B and ESSENCE demonstrated that enoxaparin was associated with a 20% reduction in death and serious cardiac ischemic events. The benefit appeared within a few days of starting therapy, was sustained through 43 days, and has been confirmed to persist one year after treatment. By contrast, in similar trials, neither dalteparin nor nadroparin was shown to be superior to UFH in the management of acute coronary syndromes. The benefit of enoxaparin demonstrated in the ESSENCE study extended across patient subgroups and was accompanied by substantial cost savings. Differences in trial design prevent direct comparisons between products, but prescribing decisions should be based on the available clinical trial evidence.
Authors:
M Cohen
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in thrombosis and hemostasis     Volume:  25 Suppl 3     ISSN:  0094-6176     ISO Abbreviation:  Semin. Thromb. Hemost.     Publication Date:  1999  
Date Detail:
Created Date:  1999-12-08     Completed Date:  1999-12-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0431155     Medline TA:  Semin Thromb Hemost     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  113-21     Citation Subset:  IM    
Affiliation:
Cardiac Catheterization Laboratories, Hahnemann Hospital, Philadelphia, Pennsylvania 19102, USA.
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MeSH Terms
Descriptor/Qualifier:
Angina, Unstable / drug therapy*
Animals
Clinical Trials as Topic
Disease Management
Drug Evaluation
Heparin, Low-Molecular-Weight / therapeutic use*
Humans
Myocardial Infarction / drug therapy*
Chemical
Reg. No./Substance:
0/Heparin, Low-Molecular-Weight

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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