Therapeutic and Side Effects of Enoxaparin over Heparin on Acute Coronary Syndrome Patients in Bali

Introduction: Acute Coronary Syndrome (ACS) is a major cause of morbidity and mortality worldwide. Anticoagulant therapies such as enoxaparin and heparin are commonly used to reduce thrombotic events, but their comparative efficacy and safety profiles remain to be fully established. This study aimed to compare the therapeutic effects and side effects of enoxaparin versus heparin in patients with ACS treated at hospitals in Bali. No randomization or blinding was performed in this observational study due to its retrospective design. This study was conducted as a cross-sectional observational study by reviewing medical records of patients diagnosed with Acute Coronary Syndrome (ACS) treated at Prof. Dr. I.G.N.G. Ngoerah Hospital and RSUD Tabanan from January 2021 to December 2023, Bali, Indonesia. Methodology: A retrospective cross-sectional observational study was conducted by reviewing medical records of ACS patients treated at Prof. Dr. I.G.N.G. Ngoerah Hospital and RSUD Tabanan, Bali, Indonesia, from January 2021 to December 2023. No randomization or blinding was performed due to the observational design. Sample size was calculated using the Lemeshow formula, with a minimum of 66 patients required. The primary outcomes were recurrence of myocardial infarction (MI) and mortality, while bleeding events were secondary outcomes. Logistic regression was employed to adjust for confounders, including age, sex, hypertension, diabetes, chronic kidney disease, and ACS subtype, Bali, Indonesia. Results: Among 73 patients (60 receiving enoxaparin, 13 receiving heparin), MI recurrence rates were 6.7% and 0%, mortality rates were 3.3% and 30.8%, and bleeding incidence was 5% and 7.7%, respectively. Mortality was significantly lower in the enoxaparin group (p = 0.008). Adjusted logistic regression revealed that hypertension significantly increased bleeding risk (adjusted OR = 29.4; 95% CI: 1.02–844.0; p = 0.049), while other factors showed no significant association. Discussion: The results suggest that enoxaparin is associated with lower mortality compared to heparin without significant differences in MI recurrence or bleeding events. The strong association between hypertension and bleeding highlights the need for careful management of hypertensive ACS patients. However, wide confidence intervals and small sample size warrant cautious interpretation, and further large-scale prospective studies are needed. Conclusion: Enoxaparin appears to be more effective in reducing mortality than heparin in ACS patients, with hypertension identified as a significant risk factor for bleeding. These findings support the preferential use of enoxaparin in this population, pending validation from larger studies.