Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina.

Théroux, Pierre; Waters, David D.; Qiu, Shiqiang; McCans, John; Guise, Pierre de; Juneau, Martin

doi:10.1161/01.cir.88.5.2045

Cited by 266 publications

(62 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[435][436][437][438][439][440] The results of studies that compared the combination of ASA and heparin with ASA alone are shown in Figure 10. In the trials that used UFH, the reduction in the rate of death or MI during the first week was 54% (p ϭ 0.016), and in the trials that used either UFH or LMWH, the reduction was 63%.…”

Section: Unfractionated Heparinmentioning

confidence: 99%

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Anderson¹,

Adams²,

Antman³

et al. 2011

Circulation

683

367

View full text Add to dashboard Cite

Section: Unfractionated Heparinmentioning

confidence: 99%

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Anderson¹,

Adams²,

Antman³

et al. 2011

Circulation

683

367

View full text Add to dashboard Cite

“…Antithrombotic strategies for the acute management of patients with unstable angina/non-Q-wave myocardial infarction (MI) include a combination of an antithrombin agent, usually an intravenous infusion of unfractionated heparin, and an antiplatelet agent, usually oral aspirin. [7][8][9][10][11][12] Beyond aspirin, optimal outpatientphase therapy for patients presenting with unstable angina/ non-Q-wave MI remains to be defined. 13 …”

mentioning

confidence: 99%

Enoxaparin Prevents Death and Cardiac Ischemic Events in Unstable Angina/Non–Q-Wave Myocardial Infarction

et al. 1999

View full text Add to dashboard Cite

MD; for the TIMI 11B Investigators* Background-Low-molecular-weight heparins are attractive alternatives to unfractionated heparin (UFH) for management of unstable angina/non-Q-wave myocardial infarction (UA/NQMI). Methods and Results-Patients (nϭ3910) with UA/NQMI were randomized to intravenous UFH for Ն3 days followed by subcutaneous placebo injections or uninterrupted antithrombin therapy with enoxaparin during both the acute phase (initial 30 mg intravenous bolus followed by injections of 1.0 mg/kg every 12 hours) and outpatient phase (injections every 12 hours of 40 mg for patients weighing Ͻ65 kg and 60 mg for those weighing Ն65 kg). The primary end point (death, myocardial infarction, or urgent revascularization) occurred by 8 days in 14.5% of patients in the UFH group and 12.4% of patients in the enoxaparin group (OR 0.83; 95% CI 0.69 to 1.00; Pϭ0.048) and by 43 days in 19.7% of the UFH group and 17.3% of the enoxaparin group (OR 0.85; 95% CI 0.72 to 1.00; Pϭ0.048). During the first 72 hours and also throughout the entire initial hospitalization, there was no difference in the rate of major hemorrhage in the treatment groups. During the outpatient phase, major hemorrhage occurred in 1.5% of the group treated with placebo and 2.9% of the group treated with enoxaparin (Pϭ0.021). Conclusions-Enoxaparin is superior to UFH for reducing a composite of death and serious cardiac ischemic events during the acute management of UA/NQMI patients without causing a significant increase in the rate of major hemorrhage. No further relative decrease in events occurred with outpatient enoxaparin treatment, but there was an increase in the rate of major hemorrhage. (Circulation. 1999;100:1593-1601.)

show abstract

“…For these groups of patients, accepted treatments include aspirin, 1 heparin, 2 and beta blockers, 3 as well as conventional anti-anginal treatments. Despite these treatments, patients with ACS remain at high risk of further ischaemic events that lead to death, new MI and recurrent angina.…”

mentioning

confidence: 99%

Managing high-risk patients with acute coronary syndromes: the Prospective Registry of Acute Ischaemic Syndromes in the UK (PRAIS-UK)

et al. 2004

View full text Add to dashboard Cite

-A study was carried out to find out whether more intense treatment (both medical and revascularisation) is targeted towards higherrisk patients with acute coronary syndromes. A prospective UK registry of patients admitted with non-ST elevation acute coronary syndromes was established to examine practice patterns and clinical outcomes with respect to the risk profile of the patients. Clinically important high-risk subgroups included the elderly, diabetics, those with heart failure and those with ST depression or bundle branch block on the presenting ECG. Elderly patients were less likely to receive evidence-based treatments, including beta blockers, statins and revascularisation. Diabetics received more revascularisation procedures but the overall revascularisation rate was low. Heart failure patients received less evidence-based treatment, with the exception of angiotensin-converting enzyme (ACE) inhibitors. Heparin was used less frequently in those with a normal ECG, although rates of revascularisation were not different when compared with those with ECG abnormalities. The conclusions of the study were that groups of patients with particularly high event rates are readily identified by their clinical characteristics, but use of evidence-based treatments and invasive investigations do not appear to be targeted towards those at greatest risk. Risk stratification and the appropriate application of treatments for patients with acute coronary syndromes need to be reviewed in the clinical setting.

show abstract

Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina.

Cited by 266 publications

References 19 publications

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Enoxaparin Prevents Death and Cardiac Ischemic Events in Unstable Angina/Non–Q-Wave Myocardial Infarction

Managing high-risk patients with acute coronary syndromes: the Prospective Registry of Acute Ischaemic Syndromes in the UK (PRAIS-UK)

Contact Info

Product

Resources

About