Abstract | BACKGROUND: METHODS: Randomised trials comparing unfractionated heparin or LMWH with placebo or untreated control, or comparing unfractionated heparin with LMWH, for the short-term and long-term management of patients with acute coronary syndrome without ST elevation, were identified by electronic and manual searches and through contact with experts and industry representatives. Odds ratios for death, myocardial infarction, and major bleeding were calculated for each trial, and results for the individual trials were combined by a modification of the Mantel-Haenszel method. FINDINGS: 12 trials, involving a total of 17157 patients, were included. The summary odds ratio (OR) for myocardial infarction or death during short-term (up to 7 days) unfractionated heparin or LMWH compared with placebo or untreated control was 0.53 (95% CI 0.38-0.73; p=0.0001) or 29 events prevented per 1000 patients treated; during short-term LMWH compared with unfractionated heparin was 0.88 (0.69-1.12; p=0.34); and during long-term LMWH (up to 3 months) compared with placebo or untreated control was 0.98 (0.81-1.17; p=0.80). Long-term LMWH was associated with a significantly increased risk of major bleeding (OR 2.26, [95% CI 1.63-3.14], p<0.0001), which is equivalent to 12 major bleeds per 1000 patients treated. INTERPRETATION:
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Authors | J W Eikelboom, S S Anand, K Malmberg, J I Weitz, J S Ginsberg, S Yusuf |
Journal | Lancet (London, England)
(Lancet)
Vol. 355
Issue 9219
Pg. 1936-42
(Jun 03 2000)
ISSN: 0140-6736 [Print] England |
PMID | 10859038
(Publication Type: Journal Article, Meta-Analysis)
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Chemical References |
- Fibrinolytic Agents
- Heparin, Low-Molecular-Weight
- Heparin
- Aspirin
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Topics |
- Acute Disease
- Aged
- Aspirin
(therapeutic use)
- Coronary Disease
(drug therapy, mortality)
- Electrocardiography
- Female
- Fibrinolytic Agents
(therapeutic use)
- Heparin
(therapeutic use)
- Heparin, Low-Molecular-Weight
(therapeutic use)
- Humans
- Male
- Middle Aged
- Randomized Controlled Trials as Topic
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