Debabrata Mukherjee, MD, MS
Does enoxaparin during percutaneous coronary intervention (PCI) reduce mortality compared with unfractionated heparin (UFH)? Do treatments differ for major bleeding?
Included studies compared enoxaparin with UFH in patients with coronary heart disease who were having PCI (primary or secondary [after fibrinolysis], or elective) in the setting of an acute coronary syndrome and reported both mortality and major bleeding outcomes.
MEDLINE and Cochrane Database of Systematic Reviews (1996 to May 2011) and abstracts from major cardiology scientific meetings (American Heart Association, American College of Cardiology, European Society of Cardiology, and Transcatheter Cardiovascular Therapeutics) were searched for randomized controlled trials (RCTs) and nonrandomized cohort studies. Experts were contacted. 23 studies (n = 30 966, 55% to 89% men) met inclusion criteria: 16 were RCTs (n = 22 259), including 4 retrospective subanalyses of RCTs, and 7 were cohort studies (n = 8707). Only the results of RCTs are reported here. 2 RCTs (n = 3362) enrolled patients having primary PCI after ST-elevation myocardial infarction, 3 (n = 8750) enrolled patients having secondary PCI, and 11 (n = 10 147) enrolled patients having elective or urgent PCI. 14 RCTs had short-term (30-d or in-hospital) follow-up.
Meta-analysis of 16 RCTs showed that enoxaparin during PCI reduced mortality compared with UFH (Table). Enoxaparin was associated with lower bleeding rates than UFH, but estimates were imprecise and included an increase in bleeding (Table).
Enoxaparin during percutaneous coronary intervention reduces mortality compared with unfractionated heparin in patients with coronary heart disease.
Results of RCTs of enoxaparin vs UFH during PCI in patients with coronary heart disease*
*PCI = percutaneous coronary intervention; RCT = randomized controlled trial; UFH = unfractionated heparin; other abbreviations defined in Glossary. Weighted event rates, RRRs, NNTs, and CIs calculated from relative risks and control event rates in article using a random-effects model.
†Includes 12 full RCTs and 4 subanalyses of RCTs.
Mukherjee D. Review: Enoxaparin during PCI is better than unfractionated heparin for reducing mortality in CHD. Ann Intern Med. ;156:JC5–2. doi: 10.7326/0003-4819-156-10-201205150-02002
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Published: Ann Intern Med. 2012;156(10):JC5-2.
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