Comparison of Low-Molecular-Weight Heparin With Unfractionated Heparin Acutely and With Placebo for 6 Weeks in the Management of Unstable Coronary Artery Disease

Klein, W.; Buchwald, A.; Hillis, Stewart; Monrad, S.; Sanz, Ginés; Turpie, Alexander G.G.; Meer, Jan van der; Olaisson, Eric; Undeland, Sven; Ludwig, K.

doi:10.1161/01.cir.96.1.61

Cited by 480 publications

(206 citation statements)

References 16 publications

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“…14 -17 Previous studies have shown that dalteparin, when added to aspirin, was superior to placebo but similar to unfractionated heparin for prevention of death and MI in patients with unstable angina/non-Q-wave MI. 18, 19 The ESSENCE (Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events) study reported that a brief course of therapy (median duration of treatment 2.6 days) of subcutaneous injections of enoxaparin 1.0 mg/kg every 12 hours was superior to intravenous unfractionated heparin in patients with unstable angina/non-Q-wave MI. 20 The TIMI 11A trial, a dose-ranging study, demonstrated that an initial 30-mg intravenous bolus followed by subcutaneous injections of 1.0 mg/kg enoxaparin every 12 hours was associated with a major hemorrhage rate of 1.9%, whereas a higher dose of 1.25 mg/kg every 12 hours was associated with a major hemorrhage rate of 6.5%.…”

Section: See P 1586mentioning

confidence: 99%

Enoxaparin Prevents Death and Cardiac Ischemic Events in Unstable Angina/Non–Q-Wave Myocardial Infarction

et al. 1999

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MD; for the TIMI 11B Investigators* 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 (nϭ3910) with UA/NQMI were randomized to intravenous UFH for Ն3 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 Ͻ65 kg and 60 mg for those weighing Ն65 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; Pϭ0.048) 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; Pϭ0.048). 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 (Pϭ0.021). 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. (Circulation. 1999;100:1593-1601.)

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Section: See P 1586mentioning

confidence: 99%

Enoxaparin Prevents Death and Cardiac Ischemic Events in Unstable Angina/Non–Q-Wave Myocardial Infarction

et al. 1999

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“…15,16 LMWHs have been investigated in several clinical circumstances, particularly the treatment of unstable angina and non-Q-wave myocardial infarction. [17][18][19][20][21] In such patients, enoxaparin has been demonstrated to be superior to UFH in preventing death, AMI, and recurrent angina, without increasing the risk of bleeding. 20,21 Despite these encouraging findings, few studies have investigated the use of LMWHs as antithrombotic adjuncts to thrombolysis.…”

mentioning

confidence: 99%

Randomized comparison of enoxaparin, a low–molecular-weight heparin, with unfractionated heparin adjunctive to recombinant tissue plasminogen activator thrombolysis and aspirin: second trial of heparin and aspirin reperfusion therapy (HART II)

Ross¹,

Molhoek²,

Lundergan³

2002

ACC Current Journal Review

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“…Dalteparin decreased the incidences of MACE such as death and AMI by 48% in the FRISC study, 23) but did not have an effect superior to that of UFH in 1,500 patients in the FRIC study. 24) In addition, dalteparin decreased MACE significantly in patients with non-Q MI, and decreased the recurrence of angina at 1-year follow-up in the ESSENCE study. 16) Furthermore, in patients with unstable angina who underwent PCI, the restenosis rate was lower in the dalteparin group than in the UFH group.…”

Section: Discussionmentioning

confidence: 92%

Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

et al. 2006

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SUMMARYThe purpose of this study was to determine the clinical outcomes of abciximab combined with the low molecular weight heparin (LMWH), dalteparin, in high-risk percutaneous coronary intervention (PCI) patients with acute myocardial infarction (AMI). A total of 140 high-risk PCI patients with AMI were divided into 2 groups: unfractionated heparin (UFH) with abciximab (group I: 70 patients, 58.7 ± 10.5 years), and dalteparin with abciximab (group II: 70 patients, 59.6 ± 9.8 years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Baseline clinical characteristics, laboratory findings, echocardiography parameters, and baseline angiographic characteristics were not different between the 2 groups. The incidence of thrombotic total occlusion lesions was 62.9% in both groups. Procedural success was achieved in 91.4% in group I and 90.0% in group II. Bleeding and hemorrhagic events were not different between the 2 groups. No significant intracranial bleeding was observed in either group. The incidence of in-hospital MACE was 7 (10.0%) in group I and 4 (5.7%) in group II. Four-year clinical follow-up was performed in 97% of the patients. Four years after PCI, death occurred in 6 (8.6%) patients in group I and in 7 (10.0%) in group II. MI occurred in 4 (5.7%) and 4 (5.7%), target vessel revascularization (TVR) in 23 (32.9%) and 16 (22.9%), and bypass surgery in 3 (4.3%) and 1 (1.4%), respectively. Overall, a MACE occurred in 33 (47.1%) patients in group I and in 26 (35.1%) patients in group II (P = 0.23). The long-term clinical outcome with dalteparin combined with abciximab may be comparable to that of UFH plus abciximab in high risk PCI patients with AMI. (Int Heart J 2006; 47: 821-831)

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Comparison of Low-Molecular-Weight Heparin With Unfractionated Heparin Acutely and With Placebo for 6 Weeks in the Management of Unstable Coronary Artery Disease

Cited by 480 publications

References 16 publications

Enoxaparin Prevents Death and Cardiac Ischemic Events in Unstable Angina/Non–Q-Wave Myocardial Infarction

Enoxaparin Prevents Death and Cardiac Ischemic Events in Unstable Angina/Non–Q-Wave Myocardial Infarction

Randomized comparison of enoxaparin, a low–molecular-weight heparin, with unfractionated heparin adjunctive to recombinant tissue plasminogen activator thrombolysis and aspirin: second trial of heparin and aspirin reperfusion therapy (HART II)

Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

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