Low-molecular weight heparin enoxaparin in the treatment of acute coronary syndromes without ST segment elevation

We compared the incidence of adverse cardiac outcomes of enoxaparin vs unfractionated heparin in the management of ACS-NSTE.

Low-molecular-weight heparins are the potential new standard in the treatment of acute coronary syndromes without ST-segment elevation (ACS-NSTE). The benefit is addressed to significant diminution of the adverse clinical events--recurrent angina (RA), myocardial infarction (MI), heart failure (HF), cerebrovascular insult (ICV), coronary artery by-pass graft (CABG), percutaneous coronary intervention (PCI) and death.

Sixty patients with ACS-NSTE were randomised to receive Enoxaparin 1 mg/kg body weight s.c twice daily (n=30) and unfractionated heparin (Heparin - "Biochemie" 25.000 IU/5 ml), according to Rashke nomogram (n=30). The end point were RA, MI, HF, ICV, CABG, PCI and death at day 180. The Kaplan-Meier estimation technique was used to compared the time to events for two treatments. A p<0.05 was considered to indicate significance.

For 180 days, RA, MI, HF, ICV and death were lower in the Enoxaparin vs UFH group (36.6% vs 73.3%, p=0.001), (30% vs 53.3%, p=0.05), (13.3% vs 23.3%, p=0.31), (3.3% vs 10%, p=0.29), (3.3% vs 10%, p=0.31), respectively. CABG were similar 13.3% (p=0.96). PCI were performing in 33.3% in UFH vs 90% in LMWH (p=0.0001).

The use of Enoxaparin in ACS-NSTE schows impressive decrease of incidence of ischemic events (Fig. 7, Ref. 8). Full Text (Free, PDF) www.bmj.sk.