Interactions between heparins, glycoprotein IIb/IIIa antagonists, and coronary intervention. The Global Registry of Acute Coronary Events (GRACE)
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Authors
Brieger, DavidVan de Werf, Frans
Avezum, Alvaro
Montalescot, Gilles
Kennelly, Brian M.
Granger, Christopher B.
Goodman, Shaun G.
Dabbous, Omar H.
Agnelli, Giancarlo
UMass Chan Affiliations
Center for Outcomes ResearchDocument Type
Journal ArticlePublication Date
2007-06-02Keywords
AdultAged
Angioplasty, Balloon, Coronary
Comorbidity
Coronary Disease
Drug Interactions
Female
Hemorrhage
Heparin
Heparin, Low-Molecular-Weight
Hospital Mortality
Humans
Male
Middle Aged
Multivariate Analysis
Platelet Glycoprotein GPIIb-IIIa Complex
*Registries
Risk Assessment
Survival Analysis
Survival Rate
Warfarin
Health Services Research
Metadata
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OBJECTIVES: The purpose of this study is to evaluate hospital mortality and major bleeding rates among patients receiving low molecular weight heparin (LMWH), unfractionated heparin (UFH), or both, and to investigate whether concomitant glycoprotein (GP) IIb/IIIa antagonists and coronary intervention affect patterns of use and outcomes with different heparins. BACKGROUND: With widespread use of glycoprotein (GP) IIb/IIIa inhibitors and invasive treatments, patients with high-risk acute coronary syndrome (ACS) may have a greater bleeding risk and may not gain additional benefit from LMWHs. The purpose of this study is to evaluate hospital mortality and major bleeding rates among patients receiving LMWH, UFH, or both, and to investigate whether concomitant GP IIb/IIIa antagonists and coronary intervention affect patterns of use and outcomes with different heparins. METHODS: Data were analyzed from 28,445 patients with ACS; 21,287 had non-ST-segment elevation myocardial infarction or unstable angina and received LMWH or UFH. RESULTS: Fifty-one percent of patients received LMWH, 32% UFH, and 17% both. The lowest inhospital mortality and bleeding rates occurred with LMWH (2.7% and 1.8% vs UFH, 4.1% and 2.7%; all P < .0001). After multivariable analysis, LMWH was associated with lower inhospital mortality rates in patients not treated with GP IIb/IIIa antagonists, irrespective of whether they had a percutaneous coronary intervention (PCI) (odds ratio 0.77, 95% confidence interval 0.63-0.94 without PCI vs odds ratio 0.45, 95% confidence interval 0.21-0.98 with PCI). Excess bleeding occurred with PCI in LMWH-treated patients. Patients older than 75 years who received GP IIb/IIIa antagonists and any antithrombotic but not PCI had an increased risk of major bleeding (LMWH 14%, UFH 8.3%). CONCLUSIONS: In patients with non-ST-elevation ACS without GP IIb/IIIa antagonists, LMWH was associated with a lower mortality rate and more bleeding episodes in PCI-treated patients than UFH; no differences occurred with GP IIb/IIIa antagonists. Elderly patients managed medically with GP IIb/IIIa antagonists and either heparin had a very high major bleeding risk.Source
Am Heart J. 2007 Jun;153(6):960-9. Link to article on publisher's siteDOI
10.1016/j.ahj.2007.03.035Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27222PubMed ID
17540196Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.ahj.2007.03.035