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Study Compares Enoxaparin, Heparin for Angioplasty

For percutaneous coronary interventions, enoxaparin is more predictable than unfractionated heparin

WEDNESDAY, Sept. 6 (HealthDay News) -- Unfractionated heparin is the standard anticoagulant used during percutaneous coronary intervention, but enoxaparin yields similar reductions in bleeding rates with more predictable anticoagulation levels, according to a study published in the Sept. 7 issue of the New England Journal of Medicine.

Gilles Montalescot, M.D., Ph.D., of the Centre Hospitalier Universitaire Pitie-Salpetriere in Paris, and colleagues conducted a study of 3,528 patients undergoing elective percutaneous coronary intervention who were randomized to receive 0.5 or 0.75 milligrams per kilogram of body weight of enoxaparin, or unfractionated heparin.

In the first 48 hours, the 0.5 mg/kg dose of enoxaparin reduced the rate of bleeding that was not related to coronary artery bypass grafting by 5.9 percent, compared with 8.5 percent for unfractionated heparin, although the higher dose enoxaparin was only associated with a 6.5 percent reduction. A higher mortality rate (10 patients, 1 percent) in the low-dose enoxaparin group led to early termination of enrollment in that group, but was not statistically higher in the final analysis compared with higher dose enoxaparin (3 patients, 0.2 percent) or unfractionated heparin (5 patients, 0.4 percent).

Compared with unfractionated heparin, both levels of enoxaparin were associated with a significant reduction in major bleeding, and more patients in the enoxaparin group reached target anticoagulation levels.

"This finding highlights the superior bioavailability of enoxaparin; in contrast, unfractionated heparin requires careful coagulation monitoring," the authors write. However, they note that the study did not explain the slightly higher death rate with low-dose enoxaparin.

The study was funded by Sanofi-Aventis.

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