The authors stated that 31 RCTS were included in the review. The number of participants was unclear.
Non-ST-elevation ACS (UA/NSTEMI).
Differences in trial design, patient selection and characteristics of the preparations made comparisons among LMWHs difficult. One trial had compared the two LMWHs enoxaparin and tinzaparin. The composite primary end point (death, reinfarction or recurrent angina) was significantly lower with enoxaparin than with tinzaparin at day 7 (12.3% versus 21.1%). This difference persisted at 30 days, but was driven almost entirely by a reduction in recurrent angina. Major bleeding was uncommon and not significantly different between the two treatment groups.
Initial medical management of ACS.
The combination of LMWH and glycoprotein IIb/IIIa inhibitors was assessed in 5 trials. The results showed that major haemorrhage occurred rarely in the LMWH and glycoprotein IIb/IIIa treatment arms (0.3% to 1.8%). In addition, no increase in bleeding was noted in patients who proceeded to PCI.
Duration of therapy with LMWH in ACS.
No additional benefit, above that observed in hospital, was shown beyond discharge among patients with ACS. In addition, an increase in bleeding with prolonged LMWH treatment was observed.
STEMI.
Eight trials assessed LMWH with fibrinolytic therapy in STEMI. Infarct-related arterial patency following fibrinolytic therapy was reported in 3 trials. The use of adjunctive LMWH resulted in improved late coronary artery patency rates and a tendency toward higher TIMI 3 flow rates in comparison with UFH. The rates of other clinical events, such as late infarct-related arterial reocclusion and recurrent ischaemia, were also reduced with LMWH compared with UFH.