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Journal of Thrombosis and Thrombolysis

, Volume 28, Issue 3, pp 325–332 | Cite as

Efficacy and safety of optimized antithrombotic therapy with aspirin, clopidogrel and enoxaparin in patients with non-ST segment elevation acute coronary syndromes in clinical practice

  • Tobias HeerEmail author
  • Claus Juenger
  • Anselm K. Gitt
  • Timm Bauer
  • Frank Towae
  • Ralf Zahn
  • Jochen Senges
  • Uwe Zeymer
  • for the Acute Coronary Syndromes (ACOS) Registry Investigators
Article

Abstract

In randomized clinical trials enoxaparin in non ST-elevation acute coronary syndromes (NSTE-ACS) has been shown to be more effective than unfractionated heparin in preventing the combined endpoint of death and myocardial infarction. Clopidogrel in combination with aspirin reduced the combined endpoint of death, myocardial infarction and stroke in NSTE-ACS patients compared to aspirin alone. Aim of the present study was to determine the clinical impact of optimized antithrombotic therapy with enoxaparin, clopidogrel and aspirin compared to standard therapy with unfractionated heparin (UFH) and aspirin in NSTE-ACS in clinical practice. We analyzed data of 2,956 consecutive patients with NSTE-ACS and either antithrombotic therapy with enoxaparin, clopidogrel and aspirin or with aspirin and UFH, which were prospectively enrolled in the acute coronary syndromes registry (ACOS) from July 2000 until the end of November 2002. After adjustment for baseline characteristics and PCI the combined endpoint of hospital death and non-fatal reinfarctions was lower in the group with optimized antithrombotic therapy including clopidogrel, enoxaparin and aspirin compared to the control-group with aspirin and UFH (odds ratio 0.30, 95% confidence interval 0.16–0.53). There was no significant difference in major bleedings between the two treatment groups (1.5% vs. 0.9%, P = 0.35), while overall there were more bleeding complications in the group with optimized antithrombotic therapy (4.9% vs. 2.0%, P = 0.005). In clinical practice optimized antithrombotic therapy with aspirin, clopidogrel and enoxaparin in NSTE-ACS is associated with a reduction in the combined endpoint of death and non-fatal reinfarctions compared to standard therapy with aspirin and UFH without increase in major bleeding complications.

Keywords

Acute coronary syndrome Clopidogrel Enoxaparin Primary percutaneous coronary intervention Prognosis Clinical practice 

Abbreviations

ACE inhibitor

Angiotensin-converting enzyme inhibitor

ACOS

Acute coronary syndromes registry

ACUTE II

Antithrombotic combination using tirofiban and enoxaparin II

ARB

Angiotensin II receptor blocker

A to Z

Aggrastat to Zocor

BMI

Body mass index (kg/m²)

CABG

Coronary artery bypasses graft

CURE

Clopidogrel in unstable angina to prevent recurrent events

ESSENCEE

Eficacy and safety of subcutaneous enoxaparin in non-Q-wave coronary events

INTERACT

Integrilin and enoxaparin randomized assessment of acute coronary syndrome treatment

LAD

Left anterior descending artery

LCX

Left circumflex artery

MACE

Major adverse cardiac event (death reinfarction)

NSTEMI

Non ST-segment elevation myocardial infarction

PCI

Percutaneous coronary intervention

RCA

Right coronary artery

SYNERGY

Superior yield of the new strategy of enoxaparin revascularization and glycoprotein IIb/IIIa inhibitors

TIMI 11B

Thrombolysis in myocardial infarction 11B

Notes

Acknowledgment

This work was supported by a grant of MSD Sharp & Dohme, Haar, Germany.

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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Tobias Heer
    • 1
    Email author
  • Claus Juenger
    • 2
  • Anselm K. Gitt
    • 2
  • Timm Bauer
    • 2
  • Frank Towae
    • 2
  • Ralf Zahn
    • 2
  • Jochen Senges
    • 3
  • Uwe Zeymer
    • 2
  • for the Acute Coronary Syndromes (ACOS) Registry Investigators
    • 2
  1. 1.Clinic AgathariedAcademic Teaching Hospital, University of MunichHaushamGermany
  2. 2.Herzzentrum LudwigshafenDepartment of Cardiology, Medizinische Klinik BLudwigshafenGermany
  3. 3.Institut für Herzinfarktforschung an der Universität HeidelbergLudwigshafenGermany

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