Enoxaparin in acute coronary syndromes

Abstract

Enoxaparin is a low-molecular-weight heparin (LMWH) derivative that exerts its anticoagulant activity through antithrombin III, an endogenous inhibitor of factor Xa and thrombin IIa. Unlike its unfractionated heparin (UFH) counterparts, enoxaparin has a greater bioavailability, lower incidence of heparin-induced thrombocytopenia and more stable and predictable anticoagulation, allowing fixed dosing without the need for monitoring. These advantages make it an attractive anticoagulant to be used in acute coronary syndrome management. Indeed, several clinical trials and meta-analyses have consistently demonstrated the efficacy of enoxaparin in reducing cardiovascular events and mortality in this population. Although initial clinical trials with enoxaparin during the early conservative approach suggested superior efficacy without differences in safety compared with UFH, emerging data in the current era of early revascularization approach indicate that superior effects of enoxaparin over heparin in reducing clinical events should be balanced against an increase in major hemorrhagic complications. Enoxaparin is a rational alternative to UFH in patients presenting with either unstable angina/non-ST-elevation myocardial infarction or ST-elevation myocardial infarction, with a clinically modest increase in bleeding complications.

Comparability of “Enoxamed” a Tunisian Generic Enoxaparin with the Originator Product: Non-clinical and Clinical Studies

“…The extent and the nature of the studies required to obtain a MAA for LMWH copies is an issue of debate [3]. Moreover, enoxaparin has consistently shown its superiority in terms of efficacy when compared to UFH and other LMWHs in the specific clinical setting of antithrombotic management of ACS [12][13][14][15].…”

Generic and Branded Enoxaparin Bioequivalence: A Clinical and Experimental Study

“…Low molecular weight heparins (LMWHs) are a family of anticoagulants that are widely used in the treatment and the prophylaxis of venous and arterial thromboembolism. In the specific clinical setting of antithrombotic management of acute coronary syndrome (ACS), the LMWH enoxaparin has consistently shown its superiority in terms of efficacy when compared to unfractionated heparin (UFH) and other LMWHs [1][2][3]. In this clinical indication, enoxaparin is now the gold standard for anticoagulation and is extensively used in everyday practice [4,5].…”

A Comparison of the Biological Activity of 2 Formulations of Enoxaparin in 12 Healthy Volunteers

“…Several clinical trials and meta-analyses have consistently demonstrated the efficacy of enoxaparin in reducing cardiovascular events and mortality in this population. [1][2][3][4] Studies from India show that LMWH, enoxaparin, is replacing UFH in the treatment of unstable angina. Calculation of costs incurred by patients in the treatment of a single episode of unstable angina at a tertiary care Indian hospital showed that the mean cost of treatment of a single episode of unstable angina in the hospital was US$494 (+271) against an annual per capita income of US$245.…”