Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis.
OBJECTIVE
To determine the efficacy and safety of enoxaparin compared with unfractionated heparin during percutaneous coronary intervention.


METHODS
Systematic review and meta-analysis.


METHODS
Medline and Cochrane database of systematic reviews, January 1996 to May 2011.


METHODS
Randomised and non-randomised studies comparing enoxaparin with unfractionated heparin during percutaneous coronary intervention and reporting on both mortality (efficacy end point) and major bleeding (safety end point) outcomes.


METHODS
Sample size, characteristics, and outcomes, extracted independently and analysed.


RESULTS
23 trials representing 30,966 patients were identified, including 10,243 patients (33.1%) undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction, 8750 (28.2%) undergoing secondary percutaneous coronary intervention after fibrinolysis, and 11,973 (38.7%) with non-ST elevation acute coronary syndrome or stable patients scheduled for percutaneous coronary intervention. A total of 13,943 patients (45.0%) received enoxaparin and 17,023 (55.0%) unfractionated heparin. Enoxaparin was associated with significant reductions in death (relative risk 0.66, 95% confidence interval 0.57 to 0.76; P<0.001), the composite of death or myocardial infarction (0.68, 0.57 to 0.81; P<0.001), and complications of myocardial infarction (0.75, 0.6 to 0.85; P<0.001), and a reduction in incidence of major bleeding (0.80, 0.68 to 0.95; P=0.009). In patients who underwent primary percutaneous coronary intervention, the reduction in death (0.52, 0.42 to 0.64; P<0.001) was particularly significant and associated with a reduction in major bleeding (0.72, 0.56 to 0.93; P=0.01).


CONCLUSIONS
Enoxaparin seems to be superior to unfractionated heparin in reducing mortality and bleeding outcomes during percutaneous coronary intervention and particularly in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction.
Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France.
Johanne
J
Silvain
Farzin
F
Beygui
Olivier
O
Barthélémy
Charles
C
Pollack
Marc
M
Cohen
Uwe
U
Zeymer
Kurt
K
Huber
Patrick
P
Goldstein
Guillaume
G
Cayla
Jean-Philippe
JP
Collet
Eric
E
Vicaut
Gilles
G
Montalescot
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D000925:Anticoagulants / Q000627:therapeutic use*; D017984:Enoxaparin / Q000627:therapeutic use*; D006470:Hemorrhage / Q000188:drug therapy; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin