Post-PCI Mortality Similar With Enoxaparin or Heparin

Both antithrombin agents are associated with few serious ischemic and hemorrhagic complications

MONDAY, Nov. 23 (HealthDay News) -- In patients undergoing elective percutaneous coronary intervention, those receiving enoxaparin have similar one-year mortality rates compared to those receiving unfractionated heparin, according to a study in the November issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

Gilles Montalescot, M.D., of the Centre Hospitalier Universitaire Pitie-Salpetriere in Paris, and colleagues randomly assigned 3,528 patients to receive either intravenous 0.50-mg/kg or 0.75-mg/kg enoxaparin or intravenous unfractionated heparin.

The researchers found that mortality rates from one month to one year were similar in the both enoxaparin and the unfractionated heparin groups (1.4, 2, and 1.5 percent versus 2.3, 2.2, and 1.9 percent). They also found that the two most important risk factors for one-year morality were nonfatal myocardial infarction and/or urgent target vessel revascularization within 30 days after the intervention, and major bleeding within 48 hours of the intervention (hazard ratios, 3.5 and 3.0, respectively).

"From this and other reports, we can conclude that elective percutaneous coronary intervention can be conducted with very few serious ischemic and hemorrhagic complications, regardless of the antithrombin agent used," states the author of an accompanying editorial. "Enoxaparin is, certainly, an acceptable alternative to unfractionated heparin or bivalirudin, and physicians should acquire the same level of familiarity with its use as they have with the time-honored, insufficiently researched, and unpredictable precursor, unfractionated heparin. It is not how we thin the blood that counts; it is how much of it we lose that predicts outcome."

This study was supported by Sanofi-Aventis; several authors reported financial relationships with the company.

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