Abstract | OBJECTIVE: DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline and Cochrane database of systematic reviews, January 1996 to May 2011. STUDY SELECTION: DATA EXTRACTION: Sample size, characteristics, and outcomes, extracted independently and analysed. DATA SYNTHESIS: 23 trials representing 30,966 patients were identified, including 10,243 patients (33.1%) undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction, 8750 (28.2%) undergoing secondary percutaneous coronary intervention after fibrinolysis, and 11,973 (38.7%) with non-ST elevation acute coronary syndrome or stable patients scheduled for percutaneous coronary intervention. A total of 13,943 patients (45.0%) received enoxaparin and 17,023 (55.0%) unfractionated heparin. Enoxaparin was associated with significant reductions in death (relative risk 0.66, 95% confidence interval 0.57 to 0.76; P<0.001), the composite of death or myocardial infarction (0.68, 0.57 to 0.81; P<0.001), and complications of myocardial infarction (0.75, 0.6 to 0.85; P<0.001), and a reduction in incidence of major bleeding (0.80, 0.68 to 0.95; P=0.009). In patients who underwent primary percutaneous coronary intervention, the reduction in death (0.52, 0.42 to 0.64; P<0.001) was particularly significant and associated with a reduction in major bleeding (0.72, 0.56 to 0.93; P=0.01). CONCLUSION:
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Authors | Johanne Silvain, Farzin Beygui, Olivier Barthélémy, Charles Pollack Jr, Marc Cohen, Uwe Zeymer, Kurt Huber, Patrick Goldstein, Guillaume Cayla, Jean-Philippe Collet, Eric Vicaut, Gilles Montalescot |
Journal | BMJ (Clinical research ed.)
(BMJ)
Vol. 344
Pg. e553
(Feb 03 2012)
ISSN: 1756-1833 [Electronic] England |
PMID | 22306479
(Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
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Chemical References |
- Anticoagulants
- Enoxaparin
- Heparin
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Topics |
- Acute Coronary Syndrome
(mortality, therapy)
- Angioplasty, Balloon, Coronary
(methods, mortality)
- Anticoagulants
(therapeutic use)
- Enoxaparin
(therapeutic use)
- Hemorrhage
(drug therapy)
- Heparin
(therapeutic use)
- Humans
- Myocardial Infarction
(mortality, therapy)
- Treatment Outcome
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