Efficacy and safety of the low-molecular weight heparin enoxaparin compared with unfractionated heparin across the acute coronary syndrome spectrum: a meta-analysis
Key result
Enoxaparin compared with unfractionated heparin in acute coronary syndromes reduced the net clinical endpoint of death, MI, or major bleeding at 30 days (12.5% vs 13.5%; OR 0.90; P=0.051).
Why the study?
Does enoxaparin improve net clinical outcomes compared to unfractionated heparin in patients with acute coronary syndromes?
Population
49,088 patients with acute coronary syndromes (STEMI or NSTEACS) pooled from 12 randomized trials
Comparison
Enoxaparin as adjunctive antithrombin therapy vs Unfractionated heparin (UFH)
Design
Meta-analysis
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Supports borderline net benefit with enoxaparin in ACS; extends meta-evidence by balancing ischemic and bleeding outcomes across subgroups.
Study Design
Type
Meta-Analysis (n=49,088)
Multicenter
Yes
Structured PICO
Does enoxaparin improve net clinical outcomes compared to unfractionated heparin in patients with acute coronary syndromes?
P
Population
49,088 patients with acute coronary syndromes (STEMI or NSTEACS) across 12 randomized trials, followed for 30 days.
I
Intervention
Enoxaparin (low-molecular weight heparin) as adjunctive antithrombin therapy
C
Comparator
Unfractionated heparin (UFH)
O
Outcome
Net clinical endpoint defined as death, MI, or major bleeding by 30 dayscomposite
Main Result
Odds Ratio: 0.9
Absolute Event Rate: 12.5% vs 13.5%
p-value: p=0.051
Enoxaparin provides a net clinical benefit over unfractionated heparin in STEMI patients, driven by reduced death or MI despite increased bleeding, but has a neutral net effect in NSTEACS.
Cite This Study
Murphy et al. (2007) conducted a meta-analysis in acute coronary syndromes (ACS) (n=49,088). enoxaparin vs. unfractionated heparin (UFH) was evaluated on net clinical endpoint (death, MI, or major bleeding by 30 days) (OR 0.90, p=0.051). Enoxaparin compared with unfractionated heparin in acute coronary syndromes reduced the net clinical endpoint of death, MI, or major bleeding at 30 days (12.5% vs 13.5%; OR 0.90; P=0.051).