Low molecular weight heparin versus unfractionated heparin in patients with acute non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug-eluting stents

Yong Jian Li, Seung-Woon Rha, Kang Yin Chen, Zhe Jin, Lin Wang, Sureshkumar Ramasamy, Kanhaiya L. Poddar, Yoshiyasu Minami, Ji Young Park, Cheol Ung Choi, Dong Joo Oh, Myung Ho Jeong

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Abstract

Background: Whether low molecular weight heparin (LMWH) enoxaparin is equivalent to unfractionated heparin (UFH) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains unclear. Methods: A total of 2397 NSTEMI patients who underwent PCI with DES received either LMWH [. n= 1178, subcutaneous enoxaparin 1. mg/kg, b.i.d., initiated after the patient's arrival and continued until 3-5 days after PCI plus reduced dose of UFH (50-70. U/kg) during PCI] or UFH (n= 1219, 24,000. U/day infusion, initiated after the patient's arrival and continued until at least 48. h after PCI). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared. Results: Enoxaparin group had similar incidences of cardiac death, total death, and total major adverse cardiac events (MACE) at 8 months compared with UFH group. The incidences of major and minor bleeding events were also similar between the two groups. Multivariable Cox regression analysis showed that enoxaparin group had similar incidences of cardiac death [adjusted odds ratio (OR) 1.16, 95% confidence interval (CI) 0.64-2.10, p= 0.620], total death (adjusted OR 1.08, 95% CI 0.66-1.76, p= 0.760), and total MACE (adjusted OR 0.94, 95% CI 0.69-1.28, p= 0.692) at 8 months as compared with UFH group. Conclusions: Enoxaparin with reduced dose of UFH only during PCI as an adjunctive antithrombotic therapy in NSTEMI patients undergoing PCI with DES was safe and showed comparable 8-month clinical outcomes as compared with UFH alone.

Original languageEnglish
Pages (from-to)22-29
Number of pages8
JournalJournal of Cardiology
Volume59
Issue number1
DOIs
Publication statusPublished - 2012 Jan 1

Fingerprint

Drug-Eluting Stents
Low Molecular Weight Heparin
Percutaneous Coronary Intervention
Enoxaparin
Heparin
Odds Ratio
Confidence Intervals
Incidence
Hemorrhage
Non-ST Elevated Myocardial Infarction
Regression Analysis

Keywords

  • Acute non-ST-segment elevation myocardial infarction
  • Drug-eluting stents
  • Enoxaparin
  • Percutaneous coronary intervention
  • Unfractionated heparin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Low molecular weight heparin versus unfractionated heparin in patients with acute non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug-eluting stents. / Li, Yong Jian; Rha, Seung-Woon; Chen, Kang Yin; Jin, Zhe; Wang, Lin; Ramasamy, Sureshkumar; Poddar, Kanhaiya L.; Minami, Yoshiyasu; Park, Ji Young; Choi, Cheol Ung; Oh, Dong Joo; Jeong, Myung Ho.

In: Journal of Cardiology, Vol. 59, No. 1, 01.01.2012, p. 22-29.

Research output: Contribution to journalArticle

Li, Yong Jian ; Rha, Seung-Woon ; Chen, Kang Yin ; Jin, Zhe ; Wang, Lin ; Ramasamy, Sureshkumar ; Poddar, Kanhaiya L. ; Minami, Yoshiyasu ; Park, Ji Young ; Choi, Cheol Ung ; Oh, Dong Joo ; Jeong, Myung Ho. / Low molecular weight heparin versus unfractionated heparin in patients with acute non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug-eluting stents. In: Journal of Cardiology. 2012 ; Vol. 59, No. 1. pp. 22-29.
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T1 - Low molecular weight heparin versus unfractionated heparin in patients with acute non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug-eluting stents

AU - Li, Yong Jian

AU - Rha, Seung-Woon

AU - Chen, Kang Yin

AU - Jin, Zhe

AU - Wang, Lin

AU - Ramasamy, Sureshkumar

AU - Poddar, Kanhaiya L.

AU - Minami, Yoshiyasu

AU - Park, Ji Young

AU - Choi, Cheol Ung

AU - Oh, Dong Joo

AU - Jeong, Myung Ho

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N2 - Background: Whether low molecular weight heparin (LMWH) enoxaparin is equivalent to unfractionated heparin (UFH) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains unclear. Methods: A total of 2397 NSTEMI patients who underwent PCI with DES received either LMWH [. n= 1178, subcutaneous enoxaparin 1. mg/kg, b.i.d., initiated after the patient's arrival and continued until 3-5 days after PCI plus reduced dose of UFH (50-70. U/kg) during PCI] or UFH (n= 1219, 24,000. U/day infusion, initiated after the patient's arrival and continued until at least 48. h after PCI). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared. Results: Enoxaparin group had similar incidences of cardiac death, total death, and total major adverse cardiac events (MACE) at 8 months compared with UFH group. The incidences of major and minor bleeding events were also similar between the two groups. Multivariable Cox regression analysis showed that enoxaparin group had similar incidences of cardiac death [adjusted odds ratio (OR) 1.16, 95% confidence interval (CI) 0.64-2.10, p= 0.620], total death (adjusted OR 1.08, 95% CI 0.66-1.76, p= 0.760), and total MACE (adjusted OR 0.94, 95% CI 0.69-1.28, p= 0.692) at 8 months as compared with UFH group. Conclusions: Enoxaparin with reduced dose of UFH only during PCI as an adjunctive antithrombotic therapy in NSTEMI patients undergoing PCI with DES was safe and showed comparable 8-month clinical outcomes as compared with UFH alone.

AB - Background: Whether low molecular weight heparin (LMWH) enoxaparin is equivalent to unfractionated heparin (UFH) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains unclear. Methods: A total of 2397 NSTEMI patients who underwent PCI with DES received either LMWH [. n= 1178, subcutaneous enoxaparin 1. mg/kg, b.i.d., initiated after the patient's arrival and continued until 3-5 days after PCI plus reduced dose of UFH (50-70. U/kg) during PCI] or UFH (n= 1219, 24,000. U/day infusion, initiated after the patient's arrival and continued until at least 48. h after PCI). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared. Results: Enoxaparin group had similar incidences of cardiac death, total death, and total major adverse cardiac events (MACE) at 8 months compared with UFH group. The incidences of major and minor bleeding events were also similar between the two groups. Multivariable Cox regression analysis showed that enoxaparin group had similar incidences of cardiac death [adjusted odds ratio (OR) 1.16, 95% confidence interval (CI) 0.64-2.10, p= 0.620], total death (adjusted OR 1.08, 95% CI 0.66-1.76, p= 0.760), and total MACE (adjusted OR 0.94, 95% CI 0.69-1.28, p= 0.692) at 8 months as compared with UFH group. Conclusions: Enoxaparin with reduced dose of UFH only during PCI as an adjunctive antithrombotic therapy in NSTEMI patients undergoing PCI with DES was safe and showed comparable 8-month clinical outcomes as compared with UFH alone.

KW - Acute non-ST-segment elevation myocardial infarction

KW - Drug-eluting stents

KW - Enoxaparin

KW - Percutaneous coronary intervention

KW - Unfractionated heparin

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