Key result
Low-molecular-weight heparin appears to have similar efficacy to unfractionated heparin during PCI for NSTEACS, but may increase the risk of bleeding when combined with glycoprotein IIb/IIIa inhibitors.
Why the study?
Does low-molecular-weight heparin (LMWH) improve efficacy or reduce bleeding compared to unfractionated heparin (UFH) in patients undergoing PCI for NSTEACS?
Does low-molecular-weight heparin (LMWH) improve efficacy or reduce bleeding compared to unfractionated heparin (UFH) in patients undergoing PCI for NSTEACS?
LMWH does not show definitive superiority over UFH for managing NSTEACS during PCI and may increase bleeding risk, especially when combined with glycoprotein IIb/IIIa inhibitors.
Supports UFH preference or LMWH caution with GP IIb/IIIa inhibitors in NSTEACS PCI; confirms similar efficacy with bleeding concern.
OBJECTIVE: To review the available literature addressing the role of low-molecular-weight heparin (LMWH) as an alternative to unfractionated heparin (UFH) in percutaneous coronary intervention (PCI) for treatment of non-ST-elevation acute coronary syndromes (NSTEACS). DATA SOURCES: A MEDLINE search (1966-March 2004) identified pertinent articles using the key words acute coronary syndromes, unstable angina, non-ST-elevation myocardial infarction, low-molecular-weight heparin, enoxaparin, dalteparin, glycoprotein IIb/IIIa receptor antagonists, abciximab, tirofiban, eptifibatide, percutaneous transluminal coronary angioplasty, and percutaneous coronary intervention. The references of these articles were reviewed for additional pertinent references. STUDY SELECTION AND DATA EXTRACTION: All human trials of LMWH in PCI for treatment of NSTEACS were evaluated. All pertinent studies were included in the review. DATA SYNTHESIS: Administration of LMWH with or without a glycoprotein IIb/IIIa inhibitor during PCI appears to be similar to UFH in terms of efficacy. LMWH, especially in combination with a glycoprotein IIb/IIIa inhibitor, may increase risk of bleeding compared with UFH. CONCLUSIONS: Available clinical trials do not provide definitive evidence to suggest superiority of LMWH over UFH when managing NSTEACS during PCI; however, dosing strategies are available if an LMWH is to be used in this setting.
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Moser et al. (2004) conducted a review in Non-ST-elevation acute coronary syndromes (NSTEACS). Low-molecular-weight heparin (LMWH) vs. Unfractionated heparin (UFH) was evaluated on Efficacy and bleeding risk. Low-molecular-weight heparin appears to have similar efficacy to unfractionated heparin during PCI for NSTEACS, but may increase the risk of bleeding when combined with glycoprotein IIb/IIIa inhibitors.
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