BACKGROUND: Severe renal insufficiency, defined as a creatinine clearance <30 mL/min, increases the risk for bleeding in elderly patients receiving enoxaparin (enoxaparin sodium) treatment. METHODS: The risk/benefit ratios of enoxaparin and unfractionated heparin (UFH) in patients with acute myocardial infarction (AMI) aged >75 years were determined by investigating the parameters of efficacy (ischaemic event, lethal outcome), safety (bleeding events, renal insufficiency) or both (composite endpoint: ischaemic event or lethal outcome or bleeding event). RESULTS: The study included 113 patients (59 male, 52.2%) with AMI aged >75 years; 36 of these patients received enoxaparin. In the patients who had severe renal insufficiency, bleeding events were more frequent in those receiving enoxaparin than in those patients who received UFH (3 vs 1, respectively; p = 0.024). Irrespective of the presence of renal insufficiency, bleeding events occurred more often in patients who received enoxaparin than in those who received UFH (13 vs 8, respectively; p = 0.007). The composite endpoint showed a nonsignificantly better profile in patients who received enoxaparin than in those who received UFH. CONCLUSION: Although the use of enoxaparin (compared with UFH) and the presence of severe renal insufficiency significantly increased the occurrence of bleeding in patients with AMI aged >75 years, the risk/benefit difference in this population was not significant.
BACKGROUND: Severe renal insufficiency, defined as a creatinine clearance <30 mL/min, increases the risk for bleeding in elderly patients receiving enoxaparin (enoxaparin sodium) treatment. METHODS: The risk/benefit ratios of enoxaparin and unfractionated heparin (UFH) in patients with acute myocardial infarction (AMI) aged >75 years were determined by investigating the parameters of efficacy (ischaemic event, lethal outcome), safety (bleeding events, renal insufficiency) or both (composite endpoint: ischaemic event or lethal outcome or bleeding event). RESULTS: The study included 113 patients (59 male, 52.2%) with AMI aged >75 years; 36 of these patients received enoxaparin. In the patients who had severe renal insufficiency, bleeding events were more frequent in those receiving enoxaparin than in those patients who received UFH (3 vs 1, respectively; p = 0.024). Irrespective of the presence of renal insufficiency, bleeding events occurred more often in patients who received enoxaparin than in those who received UFH (13 vs 8, respectively; p = 0.007). The composite endpoint showed a nonsignificantly better profile in patients who received enoxaparin than in those who received UFH. CONCLUSION: Although the use of enoxaparin (compared with UFH) and the presence of severe renal insufficiency significantly increased the occurrence of bleeding in patients with AMI aged >75 years, the risk/benefit difference in this population was not significant.
Authors: Jean-Philippe Collet; Gilles Montalescot; Giancarlo Agnelli; Frans Van de Werf; Enrique P Gurfinkel; Jose López-Sendón; Christopher V Laufenberg; Martin Klutman; Neelam Gowda; Dietrich Gulba Journal: Eur Heart J Date: 2005-06-02 Impact factor: 29.983
Authors: Elliott M Antman; David A Morrow; Carolyn H McCabe; Sabina A Murphy; Mikhail Ruda; Zygmunt Sadowski; Andrzej Budaj; Jose L López-Sendón; Sema Guneri; Frank Jiang; Harvey D White; Keith A A Fox; Eugene Braunwald Journal: N Engl J Med Date: 2006-03-14 Impact factor: 91.245
Authors: Marc Cohen; Gian Franco Gensini; Frans Maritz; Enrique P Gurfinkel; Kurt Huber; Ari Timerman; Maria Krzeminska-Pakula; Nicolas Danchin; Harvey D White; Jose Santopinto; Frederique Bigonzi; Carole Hecquet; Luc Vittori Journal: J Am Coll Cardiol Date: 2003-10-15 Impact factor: 24.094