Abstract 15664: Enoxaparin versus Unfractionated Heparin in Percutaneous Coronary Intervention: a meta-analysis
Background: Few randomized trials have directly compared another anticoagulant with Unfractionated Heparin (UFH) in Percutaneous Coronary Intervention (PCI) and were powered for hard clinical end points such as mortality.
Objective: Our objective was to perform a meta-analysis of all the studies comparing the efficacy and safety of enoxaparin with UFH in the setting of PCI.
Methods: Two reviewers independently searched MEDLINE and the Cochrane Controlled Trials Register databases along with trials presented at major cardiology conferences and identified randomized and non-randomized studies comparing enoxaparin with UFH in patients undergoing PCI. Data on sample size, baseline characteristics, and outcomes of interest were independently extracted and analyzed.
Results: Twenty-two trials including 29633 patients met the inclusion criteria. The setting of the PCI was ST-Elevation MyocardiaI Infarction (STEMI) treated with primary PCI for n =10243 patients (34.6%), post-fibrinolysis PCI for n= 8750 (29.5%) and NTSE-ACS or stable patients for n=10640 patients (34.6%). A total of 13604 patients (45.9%) received enoxaparin and 16029 patients (54.1%) received UFH. Enoxaparin use was associated with a reduction in death (RR 0.67; 95% CI, 0.58-0.77; p<0.001), death or MI (RR 0.70; 95% CI, 0.58-0.83; p<0.001), complication of MI (RR 0.75; 95% CI, 0.66-0.86; p<0.001) and also a significant reduction in the risk of major bleeding (RR 0.80; 95% CI, 0.67-0.96; p=0.016). In the higher risk group of STEMI patients treated with primary PCI the reduction of death or death or MI was particularly marked (RR 0.52; 95% CI, 0.42-0.64; p<0.001) and (RR 0.56; 95% CI, 0.42-0.76; p=0.022), as well as the reduction of major bleeding (RR 0.72; 95% CI, 0.56-0.93; p=0.01).
Conclusion: In PCI, Enoxaparin appears to be superior to UFH to reduce all-major hard ischemic and bleeding end points, with superiority particularly evident in primary PCI.
- Myocardial infarction, STEMI
- Acute coronary syndromes
- Percutaneous coronary intervention
- © 2011 by American Heart Association, Inc.