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    Patterns of use of heparins in ACS. Correlates and hospital outcomes: the Global Registry of Acute Coronary Events (GRACE)

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    Authors
    Klein, Werner
    Kraxner, Wilfried
    Hodl, Ronald
    Steg, Phillippe Gabriel
    Budaj, Andrzej
    Gulba, Dietrich C.
    Sadiq, Immad
    Van de Werf, Frans
    White, Kami
    Fox, Keith A. A.
    GRACE Investigators
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    UMass Chan Affiliations
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2003-09-06
    Keywords
    Acute Disease
    Aged
    Angina, Unstable
    Coronary Disease
    *Drug Utilization Review
    Female
    Hemorrhage
    *Heparin
    Heparin, Low-Molecular-Weight
    Hospital Mortality
    Humans
    Male
    Middle Aged
    Myocardial Infarction
    Registries
    Retrospective Studies
    Treatment Outcome
    Health Services Research
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    Abstract
    A systematic study that compares the patterns of use of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) in patients with acute coronary syndromes (ACS) has, to date, not been carried out in the "real-world" setting. The aim of this report is to identify patterns of use of UFH and LMWH and to report their correlates and outcomes in a broad spectrum of ACS patients enrolled in the observational Global Registry of Acute Coronary Events (GRACE). The use of LMWH and UFH was analysed in 13,231 ACS patients according to patient history, concomitant treatment and invasive procedures in US and non-US sites. Frequency of use in hospitals with and without facilities for percutaneous coronary interventions (PCI) was investigated, and outcomes were analysed. Results show that younger patients (<60 >years), those receiving antiplatelet therapies, thrombolytics, beta-blockers, angiotensin-converting enzyme inhibitors, patients admitted to hospitals with PCI facilities, and patients undergoing invasive procedures were more likely to receive UFH, or both UFH and LMWH than LMWH alone (80.1% enoxaparin, 19.9% other LMWH). LMWH was used less often in US than non-US sites. After adjusting for confounding variables, patients receiving LMWH had significantly lower rates of hospital mortality (P = 0.009) and major bleeding (P < 0.0001). Similar results were observed in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction or unstable angina. We can conclude that UFH tends to be used more frequently than LMWH, but hospital outcomes appeared to be better with LMWH after adjusting for covariables.
    Source
    Thromb Haemost. 2003 Sep;90(3):519-27. Link to article on publisher's site
    DOI
    10.1267/THRO03030519
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27263
    PubMed ID
    12958622
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1267/THRO03030519
    Scopus Count
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