title: Patterns of use of heparins in ACS. Correlates and hospital outcomes: the Global Registry of Acute Coronary Events (GRACE).
abstract: A systematic study that compares the patterns of use of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) in patients with acute coronary syndromes (ACS) has, to date, not been carried out in the "real-world" setting. The aim of this report is to identify patterns of use of UFH and LMWH and to report their correlates and outcomes in a broad spectrum of ACS patients enrolled in the observational Global Registry of Acute Coronary Events (GRACE). The use of LMWH and UFH was analysed in 13,231 ACS patients according to patient history, concomitant treatment and invasive procedures in US and non-US sites. Frequency of use in hospitals with and without facilities for percutaneous coronary interventions (PCI) was investigated, and outcomes were analysed. Results show that younger patients (<60 years), those receiving antiplatelet therapies, thrombolytics, beta-blockers, angiotensin-converting enzyme inhibitors, patients admitted to hospitals with PCI facilities, and patients undergoing invasive procedures were more likely to receive UFH, or both UFH and LMWH than LMWH alone (80.1% enoxaparin, 19.9% other LMWH). LMWH was used less often in US than non-US sites. After adjusting for confounding variables, patients receiving LMWH had significantly lower rates of hospital mortality (P = 0.009) and major bleeding (P < 0.0001). Similar results were observed in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction or unstable angina. We can conclude that UFH tends to be used more frequently than LMWH, but hospital outcomes appeared to be better with LMWH after adjusting for covariables.
authors.affiliation: Medizinische Universitätsklinik Graz, Klinische Abteilung für Kardiologie, Auenbruggerplatz 5, Graz, Styria 8036, Austria. we.klein@kfunigraz.ac.at
authors.forename: Werner
authors.initials: W
authors.lastname: Klein
authors.forename: Wilfried
authors.initials: W
authors.lastname: Kraxner
authors.forename: Ronald
authors.initials: R
authors.lastname: Hödl
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.forename: Dietrich
authors.initials: D
authors.lastname: Gulba
authors.forename: Immad
authors.initials: I
authors.lastname: Sadiq
authors.forename: Frans
authors.initials: F
authors.lastname: van de Werf
authors.forename: Kami
authors.initials: K
authors.lastname: White
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
mesh_terms: D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D017723:Drug Utilization Review; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin; D006495:Heparin, Low-Molecular-Weight; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006495:Heparin, Low-Molecular-Weight; D006493:Heparin