Heparin versus placebo for acute coronary syndromes

Background The cost-effectiveness of the optimal use of hospital-based acute myocardial infarction (AMI) treatments and their potential impact on coronary heart disease (CHD) mortality in China is not well known. Methods and Results The effectiveness and costs of optimal use of hospital-based AMI treatments were estimated by the CHD Policy Model-China, a Markov-style computer simulation model. Changes in simulated AMI, CHD mortality, quality-adjusted life years, and total healthcare costs were the outcomes. The incremental cost-effectiveness ratio was used to assess projected cost-effectiveness. Optimal use of 4 oral drugs (aspirin, β-blockers, statins, and angiotensin-converting enzyme inhibitors) in all eligible patients with AMI or unfractionated heparin in non–ST-segment–elevation myocardial infarction was a highly cost-effective strategy (incremental cost-effectiveness ratios approximately US $3100 or less). Optimal use of reperfusion therapies in eligible patients with ST-segment–elevation myocardial infarction was moderately cost effective (incremental cost-effectiveness ratio ≤$10 700). Optimal use of clopidogrel for all eligible patients with AMI or primary percutaneous coronary intervention among high-risk patients with non–ST-segment– elevation myocardial infarction in tertiary hospitals alone was less cost effective. Use of all the selected hospital-based AMI treatment strategies together would be cost-effective and reduce the total CHD mortality rate in China by ≈9.6%. Conclusions Optimal use of most standard hospital-based AMI treatment strategies, especially combined strategies, would be cost effective in China. However, because so many AMI deaths occur outside of the hospital in China, the overall impact on preventing CHD deaths was projected to be modest.

show abstract

“…14,16,23,28,37 When multiple treatments were applied in combination, it was assumed that the effects were independent (Table 2). 41,42 …”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Optimal Use of Acute Myocardial Infarction Treatments and Impact on Coronary Heart Disease Mortality in China

Wang

Moran²,

Liu³

et al. 2014

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…However, their potential for causing and haemorrhagic and thrombotic complications continues to arouse caution [13, 28]. Previous studies have revealed that heparin protection against coronary occlusion is independent of the activity of heparin as an anticoagulant and has been attributed largely to inhibition of complement [12] and neutrophil migration into I/R myocardium [29].…”

Section: Discussionmentioning

confidence: 99%

The non‐anticoagulant heparin‐like K5 polysaccharide derivative K5‐N,OSepi attenuates myocardial ischaemia/reperfusion injury

Collino

Pini

Mastroianni

et al. 2012

J Cellular Molecular Medi

View full text Add to dashboard Cite

Heparin and low molecular weight heparins have been demonstrated to reduce myocardial ischaemia/reperfusion (I/R) injury, although their use is hampered by the risk of haemorrhagic and thrombotic complications. Chemical and enzymatic modifications of K5 polysaccharide have shown the possibility of producing heparin-like compounds with low anticoagulant activity and strong anti-inflammatory effects. Using a rat model of regional myocardial I/R, we investigated the effects of an epimerized N-,O-sulphated K5 polysaccharide derivative, K5-N,OSepi, on infarct size and histological signs of myocardial injury caused by 30 min. ligature of the left anterior descending coronary artery followed by 1 or 24 h reperfusion. K5-N,OSepi (0.1–1 mg/kg given i.v. 15 min. before reperfusion) significantly reduced the extent of myocardial damage in a dose-dependent manner. Furthermore, we investigated the potential mechanism(s) of the cardioprotective effect(s) afforded by K5-N,OSepi. In left ventricular samples, I/R induced mast cell degranulation and a robust increase in lipid peroxidation, free radical-induced DNA damage and calcium overload. Markers of neutrophil infiltration and activation were also induced by I/R in rat hearts, specifically myeloperoxidase activity, intercellular-adhesion-molecule-1 expression, prostaglandin-E2 and tumour-necrosis-factor-α production. The robust increase in oxidative stress and inflammatory markers was blunted by K5-N,OSepi, in a dose-dependent manner, with maximum at 1 mg/kg. Furthermore, K5-N,OSepi administration attenuated the increase in caspase 3 activity, Bid and Bax activation and ameliorated the decrease in expression of Bcl-2 within the ischaemic myocardium. In conclusion, we demonstrate that the cardioprotective effect of the non-anticoagulant K5 derivative K5-N,OSepi is secondary to a combination of anti-apoptotic and anti-inflammatory effects.

show abstract

“…NSTEMI can be differentiated from unstable angina pectoris by the presence of elevated cardiac enzymes indicating actual progression to myocardial infarction and necrosis. Both unstable angina pectoris and NSTEMI are differentiated from STEMI in that they are not amenable to either immediate reperfusion therapy with systemic fibrinolytic therapy or immediate percutaneous coronary intervention (PCI) [7].…”

Section: General Considerationsmentioning

confidence: 99%

Treatment of ischaemic heart disease in haemophilia patients: an institutional guideline

Schutgens¹,

Tuinenburg²,

Roosendaal³

et al. 2009

Haemophilia

153

View full text Add to dashboard Cite

Since the introduction of clotting factor concentrates, life expectancy of haemophilia patients is increasing and now approaches that of the general male population. Increasingly, haemophilia patients are confronted with age-related co-morbidity, including ischaemic cardiovascular disease. Treatment of stable angina pectoris and the acute coronary syndrome with antithrombotic therapy and percutaneous coronary intervention in haemophilia patients is feasible, but requires a tight co-operation between all specialists involved. As evidence-based guidelines are lacking, we developed a protocol on how we will treat haemophilia patients with ischaemic heart disease.

show abstract

Heparin versus placebo for acute coronary syndromes

Cited by 9 publications

References 51 publications

Cost-Effectiveness of Optimal Use of Acute Myocardial Infarction Treatments and Impact on Coronary Heart Disease Mortality in China

Cost-Effectiveness of Optimal Use of Acute Myocardial Infarction Treatments and Impact on Coronary Heart Disease Mortality in China

The non‐anticoagulant heparin‐like K5 polysaccharide derivative K5‐N,OSepi attenuates myocardial ischaemia/reperfusion injury

Treatment of ischaemic heart disease in haemophilia patients: an institutional guideline

Contact Info

Product

Resources

About