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Prospective comparison of hemorrhagic complications after treatment with enoxaparin versus unfractionated heparin for unstable angina pectoris or non-ST-segment elevation acute myocardial infarction.

Publication ,  Journal Article
Berkowitz, SD; Stinnett, S; Cohen, M; Fromell, GJ; Bigonzi, F; ESSENCE Investigators,
Published in: Am J Cardiol
December 1, 2001

Patients with unstable angina pectoris (UAP) or non-ST-segment elevation acute myocardial infarction (AMI) are at risk of death or recurrent ischemic events, despite receiving aspirin and unfractionated heparin (UFH). This study investigates the effect of the low molecular weight heparin, enoxaparin, on the incidence of hemorrhage and thrombocytopenia in relation to baseline characteristics and subsequent invasive procedures. Rates of hemorrhage and thrombocytopenia were analyzed for UAP or non-ST-segment elevation AMI in patients included in the prospective, randomized, double-blind Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) study. Patients received either enoxaparin or UFH, plus aspirin, for 2 to 8 days. The overall rate of major hemorrhage (at 30 days) was comparable between the 2 groups (6.5% for enoxaparin vs. 7.0% for UFH, p = 0.6). The rate of major hemorrhage while on treatment was slightly higher in the enoxaparin group, but this was not significant (1.1% vs 0.7% for UFH, p = 0.204), as was the rate of major hemorrhage within 48 hours of coronary artery bypass grafting performed within 12 hours of treatment. However, the rate of minor hemorrhage was significantly higher in the enoxaparin group, with the majority being injection-site ecchymoses or hematomas (11.9% vs. 7.2% with UFH, p <0.001). Thrombocytopenia (platelet count <100,000 per mm(3)) occurred mainly in association with coronary bypass surgery, with a similar rate in both groups. Thus, enoxaparin is a well-tolerated alternative to UFH in the management of UAP or non-ST-segment elevation AMI. Despite the more effective antithrombotic effect, which results in fewer ischemic events, enoxaparin is not associated with an increase in the rate of major hemorrhagic complications, and is not significantly associated with thrombocytopenia, but is associated with an increase in minor injection site ecchymosis.

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Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

December 1, 2001

Volume

88

Issue

11

Start / End Page

1230 / 1234

Location

United States

Related Subject Headings

  • Thrombocytopenia
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Heparin
  • Hemorrhage
  • Female
  • Enoxaparin
 

Citation

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Berkowitz, S. D., Stinnett, S., Cohen, M., Fromell, G. J., Bigonzi, F., & ESSENCE Investigators, . (2001). Prospective comparison of hemorrhagic complications after treatment with enoxaparin versus unfractionated heparin for unstable angina pectoris or non-ST-segment elevation acute myocardial infarction. Am J Cardiol, 88(11), 1230–1234. https://doi.org/10.1016/s0002-9149(01)02082-3
Berkowitz, S. D., S. Stinnett, M. Cohen, G. J. Fromell, F. Bigonzi, and F. ESSENCE Investigators. “Prospective comparison of hemorrhagic complications after treatment with enoxaparin versus unfractionated heparin for unstable angina pectoris or non-ST-segment elevation acute myocardial infarction.Am J Cardiol 88, no. 11 (December 1, 2001): 1230–34. https://doi.org/10.1016/s0002-9149(01)02082-3.
Journal cover image

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

December 1, 2001

Volume

88

Issue

11

Start / End Page

1230 / 1234

Location

United States

Related Subject Headings

  • Thrombocytopenia
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Heparin
  • Hemorrhage
  • Female
  • Enoxaparin