Enoxaparin effective alternative to heparin
Enoxaparin (Clexane) is an effective alternative to heparin for patients with acute coronary syndromes who need anticoagulant therapy, according to three new studies.
The first compared outcomes of patients treated with either drug used
as the principal anticoagulant. The researchers, from the Duke Clinical
Research Institute in Durham, North Carolina, found that death or non-fatal
myocardial infarction (MI) occurred in 14.0 per cent of patients treated
with enoxaparin and 14.5 per cent of patients treated with
heparin. They concede that enoxaparin carries a modest increase in risk
of major bleeding but conclude that this drug is likely to be superior
to unfractionated heparin when used as first-line therapy.
In the second study, researchers from the same institute examined whether
a combination of enoxaparin with the glycoprotein IIb/IIIa inhibitor
tirofiban (Aggrastat) and
aspirin was a suitable alternative to unfractionated heparin with tirofiban
and aspirin in nearly 4,000 patients.
They found a 1 per cent absolute and 12 per cent relative difference
in favour of enoxaparin for the prevention of death,
recurrent MI or refractory ischaemia.
A third study, a meta-analysis combining data from older studies with
the two new
trials, showed a significant reduction in the 30-day composite of death
or MI with enoxaparin (odds ratio 0.91; 95 per cent confidence interval
0.83–0.99). Enoxaparin had a greater beneficial effect among patients
who had received no antithrombin therapy before being recruited into
a trial (odds ratio 0.81; 0.70–0.94).
The studies are published in JAMA (2004;292:45, 55 and 89). |
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