June 28, 2007European Heart Journal196 citationsOpen Access
View Full PaperEfficacy 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).
Study Design
Type
Meta-Analysis (n=49,088)
Multicenter
Yes
PICO
P
Population
49,088 patients with acute coronary syndromes (STEMI or NSTEACS) across 12 randomized trials, followed for 30 days.
I
Intervention / Comparator
enoxaparin vs unfractionated heparin (UFH)
O
Primary Outcome
net clinical endpoint (death, MI, or major bleeding by 30 days) — OR 0.90, p=0.051
Main Result
Odds Ratio: 0.9
Absolute Event Rate: 12.5% vs 13.5%
p-value: p=0.051
Abstract
AIMS: To determine whether the low-molecular weight heparin enoxaparin remains favourable when compared with unfractionated heparin (UFH) among patients with acute coronary syndromes (ACS) when incorporating efficacy and safety of these adjunctive therapies using a net clinical endpoint. METHODS AND RESULTS: We performed a meta-analysis of randomized trials of enoxaparin vs. UFH in ST-elevation-MI (STEMI) or non-ST-elevation-ACS (NSTEACS) (n = 49,088 patients in 12 trials). The net clinical endpoint was defined as death, MI, or major bleeding by 30 days. Death or myocardial infarction (MI) was significantly reduced with enoxaparin when compared with UFH (9.8 vs. 11.4%, OR 0.84, P 49 000 patients across the ACS spectrum. Although bleeding was increased with enoxaparin, this increase was offset by a reduction in death or MI. The net clinical benefit in favour of enoxaparin was evident among the STEMI population and was neutral among the NSTEACS population.