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Enoxaparin Found to be Superior to Unfractionated Heparin in Acute Coronary Syndromes
Henry I. Bussey, Pharm.D., FCCP, FAHA
August 2004
Drs. Moore, Linn, and O'Rourke from the University of Texas Health Science Center in San Antonio conclude that "This systematic overview of 21,946 patients comparing enoxaparin with UH (unfractionated heparin) in treatment of NSTEMI ACS (non-ST elevation myocardial infarction, acute coronary syndrome) demonstrates that enoxaparin is more effective than UH in preventing the composite of death or nonfatal infarction at 30 days with no difference in episodes of major bleeding or need for transfusion. In those patients who have not received prior antithrombin therapy, enoxaparin is superior to UH as a first-line agent in ACS."
However, while the data support their findings, Raschke, et al pointed out in 2003 that such studies may be seriously flawed because the sensitivity of reagents used for measuring the aPTT has increased in recent years so that traditionally used aPTT values now represent subtherapeutic levels of heparin. Perhaps further research is needed, but unless and until other data are forthcoming, enoxaparin would appear to be the better therapy.
References
1. Moore TD, Linn WD, O'Rourke RA. Hot Topic: Are Low-Molecular Weight Heparins Superior to Unfractionated Heparin for Antithrombin Therapy in Non-ST-Segment Elevation Acute Coronary Syndromes. Hurst's the Heart 2004.
2. Raschke RA, Hirsh J, Guidry JR. Suboptimal monitoring and dosing of unfractionated heparin in comparative studies with low-molecular-weight heparin. Ann Intern Med 2003; 138:720-723.
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