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Heparin versus placebo for acute coronary syndromesMagee KD, Campbell SG, Moher D, Rowe BH
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SummaryHeparins reduce the number of heart attacks but caused more minor bleeding after acute coronary syndromes compared to placebo.Blood clots in the arteries leading to the heart can cause acute coronary syndromes: unstable angina (a feeling of tightness in the chest) or a type of heart attack (non-ST segment myocardial infarction - NSTEMI). Drugs that prevent clots from forming (such as aspirin) or thin the blood (such as heparin) can relieve the problem. Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are two types of heparin. This review of trials found that UFH and LMWH when given to patients with high-risk unstable angina or NSTEMI in the acute phase of treatment in addition to standard therapy with aspirin, prevent more heart attacks than placebo but do not reduce mortality, the need for revascularization procedures or recurrent angina. Although there was limited reporting of side effects, heparins caused more cases of minor bleeding.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 16. 2008 AbstractBackgroundAcute coronary syndromes (ACS) represent a spectrum of disease including unstable angina (UA) and non-ST segment myocardial infarction (NSTEMI). Despite treatment with aspirin, beta-blockers and nitroglycerin, UA/NSTEMI is still associated with significant morbidity and mortality. Although emerging evidence suggests that low molecular weight heparin (LMWH) is more efficacious compared to unfractionated heparin (UFH), there is limited data to support the role of heparins as a drug class in the treatment of ACS. ObjectivesTo determine the effect of heparins (UFH and LMWH) compared with placebo for the treatment of patients with ACS. Search strategyWe searched the Cochrane Central Register of Controlled Trials on The Cochrane Library (issue 4, 2002), MEDLINE (1966 to May 2002), EMBASE (1980 to May 2002) and CINAHL (1982 to May 2002). Authors of included studies and pharmaceutical industry representatives were contacted to determine if unpublished studies which met the inclusion criteria were available. Selection criteriaRandomized controlled trials of parenteral UFH or LMWH versus placebo in people with ACS (UA or NSTEMI). Data collection and analysisTwo reviewers independently assessed quality of studies. Data were extracted independently by two reviewers. Study authors were contacted to verify and clarify missing data. Main resultsEight studies (3118 participants) were included in this review. We found no evidence for difference in overall mortality between the groups treated with heparin and placebo (RR = 0.84, 95% CI 0.36 to 1.98). Heparins reduced the occurrence of MI (RR = 0.40, 95% CI 0.25 to 0.63, NNT = 33). An increase in the incidence of minor bleeds (RR = 6.80, 95% CI 1.23 to 37.49, NNH = 17). Authors' conclusionsCompared to placebo, patients treated with heparins had similar risk of mortality, revascularization, recurrent angina, major bleeding and thrombocytopenia. However, those treated with heparins had decreased risk of MI and a higher incidence of minor bleeding. |
