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dc.contributor.authorKlein, Werner
dc.contributor.authorKraxner, Wilfried
dc.contributor.authorHodl, Ronald
dc.contributor.authorSteg, Phillippe Gabriel
dc.contributor.authorBudaj, Andrzej
dc.contributor.authorGulba, Dietrich C.
dc.contributor.authorSadiq, Immad
dc.contributor.authorVan de Werf, Frans
dc.contributor.authorWhite, Kami
dc.contributor.authorFox, Keith A. A.
dc.contributor.authorGRACE Investigators
dc.date2022-08-11T08:08:09.000
dc.date.accessioned2022-08-23T15:44:12Z
dc.date.available2022-08-23T15:44:12Z
dc.date.issued2003-09-06
dc.date.submitted2011-09-23
dc.identifier.citationThromb Haemost. 2003 Sep;90(3):519-27. <a href="http://dx.doi.org/10.1267/THRO03030519">Link to article on publisher's site</a>
dc.identifier.issn0340-6245 (Linking)
dc.identifier.doi10.1267/THRO03030519
dc.identifier.pmid12958622
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27263
dc.description.abstractA 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=12958622&dopt=Abstract">Link to Article in PubMed</a>
dc.subjectAcute Disease
dc.subjectAged
dc.subjectAngina, Unstable
dc.subjectCoronary Disease
dc.subject*Drug Utilization Review
dc.subjectFemale
dc.subjectHemorrhage
dc.subject*Heparin
dc.subjectHeparin, Low-Molecular-Weight
dc.subjectHospital Mortality
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMyocardial Infarction
dc.subjectRegistries
dc.subjectRetrospective Studies
dc.subjectTreatment Outcome
dc.subjectHealth Services Research
dc.titlePatterns of use of heparins in ACS. Correlates and hospital outcomes: the Global Registry of Acute Coronary Events (GRACE)
dc.typeJournal Article
dc.source.journaltitleThrombosis and haemostasis
dc.source.volume90
dc.source.issue3
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1080&amp;context=cor_grace&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace/81
dc.identifier.contextkey2255002
refterms.dateFOA2022-08-23T15:44:12Z
html.description.abstract<p>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.</p>
dc.identifier.submissionpathcor_grace/81
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages519-27


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