title: A comparison of enoxaparin with unfractionated heparins in patients with coronary heart disease in an emergency department in rural South Indian tertiary care teaching hospital.
abstract: OBJECTIVE
  Antithrombotic therapy with heparin plus antiplatelets reduces the rate of ischemic events in patients with coronary heart disease. Low molecular weight heparin has a more predictable anticoagulant effect than standard unfractionated heparin, is easier to administer, does not require monitoring and is associated with less ADRs. The purpose of the present study was to evaluate and compare the clinical and cost outcomes of Enoxaparin with a standard unfractionated heparin in patients with coronary heart disease.
  
  
  METHODS
  This was a noninvasive prospective observational descriptive study carried out at a multi-specialty tertiary care teaching hospital situated in rural Tamil Nadu, India. Male and female coronary heart disease (CHD) patients aged 35-75 years newly diagnosed or those having a history of CHD were included. The intervention group received enoxaparin for 5 days. A series of resting the electrocardiogram, prothrombin time and ADRs were measured in all patients during days 1 and 21 respectively.
  
  
  RESULTS
  Compared to unfractionated heparin group of patients, the average prothrombin time was significantly higher (P < 0.0001) whereas hypokalemia was significantly lower (P < 0.02) in enoxaparin group of patients. Even though recurrence of angina and ADRs such as bleeding, nausea, headache and sudden cough occurred less frequently in the enoxaparin group of patients compared to unfractionated heparin group of patients, the differences were not significant.
  
  
  CONCLUSIONS
  Antithrombotic therapy with enoxaparin plus aspirin was safer and more effective than unfractionated heparin plus aspirin, in reducing the incidence of ischemic events in patients with unstable angina or myocardial infarction in the early phase.
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, No. 1 Jalan Menara Gading, UCSI Heights, Cheras 56000, Kuala Lumpur, Malaysia ; Department of Pharmacy Practice, Annamalai University, Tamil Nadu, India.
authors.forename: Akram
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Department of Biopharmaceutical Sciences, Shenandoah University, Winchester, VA, USA.
authors.forename: Isha
authors.initials: I
authors.lastname: Patel
authors.affiliation: Department of Pharmacy Practice, Annamalai University, Tamil Nadu, India.
authors.forename: Himani
authors.initials: H
authors.lastname: Asani
authors.affiliation: Department of Pharmacy Practice, Annamalai University, Tamil Nadu, India.
authors.forename: M
authors.initials: M
authors.lastname: Jagadeesan
authors.affiliation: Department of Pharmacy Practice, Annamalai University, Tamil Nadu, India.
authors.forename: S
authors.initials: S
authors.lastname: Parimalakrishnan
authors.affiliation: Department of Medicine, Rajah Muthiah Medical College and Hospital, Annamalai University, Tamil Nadu, India.
authors.forename: S
authors.initials: S
authors.lastname: Selvamuthukumaran
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000191:economics; D017984:Enoxaparin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006493:Heparin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D017721:Hospital Costs; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011517:Prothrombin Time; D019035:Rural Health Services / Q000191:economics; D062606:Tertiary Care Centers / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006493:Heparin; D001241:Aspirin
keywords: Anticoagulant; and efficacy; coronary heart disease; enoxaparin; safety; unfractionated heparin
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