Heparin versus placebo for non-ST elevation acute coronary syndromes

Andrade-Castellanos, Carlos A; Colunga‐Lozano, Luis Enrique; Delgado-Figueroa, Netzahualpilli; Magee, Kirk

doi:10.1002/14651858.cd003462.pub3

Cited by 10 publications

(6 citation statements)

References 70 publications

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“…Conversely, our results reinforce the findings of previous studies, wherein no significant difference of mortality between the 2 groups was identified. Moreover, the results of previous studies were inconsistent even with respect to the composite end points, with some of them finding no protective effect of PACT in patients with NSTE-ACS .…”

Section: Discussionsupporting

confidence: 92%

Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non–ST-Segment Elevation Acute Coronary Syndrome

Chen

Liu

et al. 2019

JAMA Intern Med

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The association of parenteral anticoagulation therapy with improved outcomes in patients with non-ST-segment elevation acute coronary syndrome was previously established. This benefit has not been evaluated in the era of dual antiplatelet therapy and percutaneous coronary intervention. OBJECTIVE To evaluate the association between parenteral anticoagulation therapy and clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 8197 adults who underwent percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome from January 1, 2010, to December 31, 2014, at 5 medical centers in China. Patients receiving parenteral anticoagulation therapy only after percutaneous coronary intervention were excluded. EXPOSURES Parenteral anticoagulation therapy. MAIN OUTCOMES AND MEASURES The primary outcome was in-hospital all-cause death and in-hospital major bleeding as defined by the Bleeding Academic Research Consortium definition (grades 3-5). RESULTS Of 6804 patients who met the final criteria, 5104 (75.0%) were male, with a mean (SD) age of 64.2 (10.4) years. The incidence of in-hospital death was not significantly different between the patients who received and did not receive parenteral anticoagulation therapy (0.3% vs 0.1%; P = .13) (adjusted odds ratio, 1.27; 95% CI, 0.38-4.27; P = .70). A similar result was found for myocardial infarction (0.3% vs 0.3%; P = .82) (adjusted odds ratio, 0.77; 95% CI, 0.29-2.07; P = .61). In-hospital major bleeding was more frequent in the parenteral anticoagulation group (2.5% vs 1.0%; P < .001) (adjusted odds ratio, 1.94; 95% CI, 1.24-3.03; P = .004). At a median (interquartile range) follow-up of 2.96 years (1.93-4.46 years), all-cause death was not significantly different between the 2 groups (adjusted hazards ratio, 0.87; 95% CI, 0.71-1.07; P = .19), but the incidence of major bleeding was higher in the parenteral anticoagulation group (adjusted hazards ratio, 1.43; 95% CI, 1.01-2.02; P = .04). The propensity score analysis confirmed these primary analyses. CONCLUSIONS AND RELEVANCE In the patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome, parenteral anticoagulation therapy was not associated with a lower risk of all-cause death or myocardial infarction but was significantly associated with a higher risk of major bleeding. These findings raise important safety questions about the current practice of routine parenteral anticoagulation therapy while we await randomized trials of this practice.

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Section: Discussionsupporting

confidence: 92%

Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non–ST-Segment Elevation Acute Coronary Syndrome

Chen

Liu

et al. 2019

JAMA Intern Med

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“…Major and minor bleeding were increased (RR 2.05, 95% CI 0.91-4.60 and RR 6.80, 95% CI 1.23-37.49 respectively). [170].…”

Section: Thrombocytopaenia and High Bleeding Riskmentioning

confidence: 99%

National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016

Chew

Scott

Cullen

et al. 2016

Heart, Lung and Circulation

290

295

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“…On the other hand, such ICH patients with ACS, including non-ST segment myocardial infarction and unstable angina had decreased risk of AMI; however the use of heparins were similar to placebo in terms of the risk of mortality, revascularization, recurrent angina, and thrombocytopenia. 24 …”

Section: Prognosismentioning

confidence: 99%

Elevated troponin in patients with acute stroke – Is it a true heart attack?

Dous

Grigos

Grodman

2017

The Egyptian Heart Journal

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Although the prognostic value of a positive troponin in an acute stroke patient is still uncertain, it is a commonly encountered clinical situation given that Ischemic Heart Disease (IHD) and cerebrovascular disease (CVD) frequently co-exist in the same patient and share similar risk factors. Our objectives in this review are to (1) identify the biologic relationship between acute cerebrovascular stroke and elevated troponin levels, (2) determine the pathophysiologic differences between positive troponin in the setting of acute stroke versus acute myocardial infarction (AMI), and (3) examine whether positive troponin in the setting of acute stroke has prognostic significance. We also will provide an insight analysis of some of the available studies and will provide guidance for a management approach based on the available data according to the current guidelines.

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Heparin versus placebo for non-ST elevation acute coronary syndromes

Cited by 10 publications

References 70 publications

Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non–ST-Segment Elevation Acute Coronary Syndrome

Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non–ST-Segment Elevation Acute Coronary Syndrome

National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016

Elevated troponin in patients with acute stroke – Is it a true heart attack?

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