Abstract | CONTEXT: OBJECTIVE: DATA SOURCES: The primary data sets for ESSENCE, A to Z, and SYNERGY were available at the Duke Clinical Research Institute. Baseline characteristics and event frequencies for TIMI 11B, ACUTE II, and INTERACT were provided by the principal investigator of each study. STUDY SELECTION: DATA EXTRACTION: Efficacy and safety end points were extracted from the overall trial populations and the subpopulation receiving no antithrombin therapy prior to randomization. DATA SYNTHESIS: Systematic evaluation of the outcomes for 21 946 patients was performed using a random-effects empirical Bayes model. No significant difference was found in death at 30 days for enoxaparin vs unfractionated heparin (3.0% vs 3.0%; odds ratio [OR], 1.00; 95% confidence interval [CI], 0.85-1.17). A statistically significant reduction in the combined end point of death or nonfatal MI at 30 days was observed for enoxaparin vs unfractionated heparin in the overall trial populations (10.1% vs 11.0%; OR, 0.91; 95% CI, 0.83-0.99; number needed to treat, 107). A statistically significant reduction in the combined end point of death or MI at 30 days was also observed for enoxaparin in the populations receiving no prerandomization antithrombin therapy (8.0% vs 9.4%; OR, 0.81; 95% CI, 0.70-0.94; number needed to treat, 72). No significant difference was found in blood transfusion (OR, 1.01; 95% CI, 0.89-1.14) or major bleeding (OR, 1.04; 95% CI, 0.83-1.30) at 7 days after randomization in the overall safety population or in the population of patients receiving no prerandomization antithrombin therapy. CONCLUSION: In a systematic overview of approximately 22 000 patients across the spectrum of ACS, enoxaparin is more effective than unfractionated heparin in preventing the combined end point of death or MI.
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Authors | John L Petersen, Kenneth W Mahaffey, Vic Hasselblad, Elliott M Antman, Marc Cohen, Shaun G Goodman, Anatoly Langer, Michael A Blazing, Anne Le-Moigne-Amrani, James A de Lemos, Christopher C Nessel, Robert A Harrington, James J Ferguson, Eugene Braunwald, Robert M Califf |
Journal | JAMA
(JAMA)
Vol. 292
Issue 1
Pg. 89-96
(Jul 07 2004)
ISSN: 1538-3598 [Electronic] United States |
PMID | 15238596
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
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Chemical References |
- Enoxaparin
- Fibrinolytic Agents
- Heparin
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Topics |
- Angina Pectoris
(drug therapy, mortality)
- Angina, Unstable
(drug therapy)
- Cause of Death
- Enoxaparin
(adverse effects, therapeutic use)
- Fibrinolytic Agents
(adverse effects, therapeutic use)
- Hemorrhage
(epidemiology)
- Heparin
(adverse effects, therapeutic use)
- Humans
- Myocardial Infarction
(drug therapy)
- Randomized Controlled Trials as Topic
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