Head-to-Head Comparison of Two Different Low-Molecular-Weight Heparins in Acute Coronary Syndrome. A Single Center Experience.

Abstract

SUMMARYLow-molecular-weight heparins (LMWH) of different types have yielded different results when used in the setting of unstable angina (UA) or non Q-wave myocardial infarction (NQMI). We compared the safety and therapeutic efficacy of two different LMWHs, namely dalteparin (Dalt.) and enoxaparin (Enox.), in the acute phase (first 5 days) of UA or NQMI.One hundred and forty-two patients with UA/NQMI were randomly assigned to treatment with either Dalt. [120 IU/kg twice daily by subcutaneous (SC) injection] or Enox.[1 mg/kg twice daily by SC injection]. The occurrence of any one of death, myocardial infarction, or angina recurrence within 5 days of the first LMWH injection was the endpoint of the study. There were 69 patients in the Enox. group (53 males, 16 females, mean age : 60.3±11.9) and 73 patients in the Dalt. group (54 males, 19 females, mean age : 59.6 ±10.3). The baseline characteristics of the patients in the two groups were similar. There were no deaths in either group. Myocardial infarction occurred in two patients in the Dalt. group (4%). Angina recurrence was seen in 11 patients in the Enox. group (16%) and in 11 patients in the Dalt. group (15%). Overall, any of the events that made up the endpoint occurred in 11 (16%) and 14 (19%) patients in the Enox. and Dalt. groups, respectively (P>0.05). The time to occurrence of the first event, however, was significantly longer in the Enox. group (82.3±33.2 versus 37.6±23.4 hours, P=0.007). Thrombocytopenia and allergic reactions were not detected in any patient. Major bleeding was seen in 1 patient in the Enox. group. Minor bleeding occurred in 17 (25%) and 21 (29%) patients in the Enox. and Dalt. groups, respectively (P>0.05).Enoxaparin and dalteparin were found to be equally safe and effective for the early management of UA/NQMI, but enoxaparin appeared to delay the occurrence of MI or angina recurrence as compared to dalteparin in this setting. (Jpn Heart J 2002; 43: 433-442)

Anticoagulation in the Management of Non-ST-Segment Elevation Acute Coronary Syndrome

“…35 Similar results were obtained after 6 and 12 months. 38 A significantly higher incidence of non-coronary artery bypass graft (CABG) -related TIMI major bleeding (Table 3) at 30 days was associated with enoxaparin compared to UFH.…”

“…28 Countering this last argument, however, is the significant finding that the primary end point was already statistically significantly in favor of enoxaparin by 48 hours (4.9% vs 6.3%; P ¼ .02). 35 While there has been a published trial comparing enoxaparin to dalteparin in patients with NSTE ACS, this was a single-center, nonrandomized, nonblinded trial of only 142 patients, which was much too small to produce any conclusions. 35 There is 1 trial comparing enoxaparin to tinzaparin in patients with NSTE ACS.…”

“…35 While there has been a published trial comparing enoxaparin to dalteparin in patients with NSTE ACS, this was a single-center, nonrandomized, nonblinded trial of only 142 patients, which was much too small to produce any conclusions. 35 There is 1 trial comparing enoxaparin to tinzaparin in patients with NSTE ACS. The Enoxaparin Versus Tinzaparin in Non-ST-segment Elevation Acute Coronary Syndromes (EVET) trial compared enoxaparin (1 mg/kg every 12 hours) to tinzaparin (175 IU/kg once daily) in 438 NSTE ACS patients in a randomized, single-center, open-label fashion.…”