A meta-analysis of controlled clinical trials comparing low-molecular weight heparins with unfractionated heparin in unstable angina.
Indian Heart J
;
2001 Mar-Apr; 53(2): 197-202
Article
in English
| IMSEAR
| ID: sea-6002
ABSTRACT
BACKGROUND:
Unfractionated heparin has been used extensively for the treatment of unstable angina/non-Q wave myocardial infarction but it has several disadvantages. Low-molecular weight heparins are now recommended although they are 3-5 times costlier than unfractionated heparin since they are convinient to administer and do not require activated thromboplastin time monitoring. Whereas enoxaparin, a low-molecular weight heparin, has been demonstrated to be superior to unfractionated heparin, the results of other low-molecular weight heparins have not been so convincing. METHOD ANDRESULTS:
Through manual, MEDLINE and EMBASE search, we identified five randomized trials (excluding enoxaparin trials) that compared low-molecular weight heparins with unfractionated heparin in unstable angina. The prespecified efficacy end point of interest included a composite of death, myocardial infarction, recurrent angina and urgent revascularization. The safety end point was taken as a composite of major hemorrhage, minor hemorrhage, thrombocytopenia, allergic reaction and any other adverse event. We calculated odds ratio (95% confidence interval) for each trial for the composite end point, and the pooled odds ratio (95%) confidence interval) was calculated using two established methods of meta-analysis, the Mantel-Haenszel-Peto method and the DerSirmonian-Laird method. Both the methods yielded similar odds ratio (95% confidence interval). Separate odds ratio were calculated for efficacy and safety end points. There was a nonsignificant reduction in the incidence of the composite efficacy end point the odds ratio (95% confidence interval) was 0.83 (0.70-0.99 p=0.08). The odds ratio (95% confidence interval) for the safety data was 0.78 (0.69-1.26 p=0.33).CONCLUSIONS:
No statistically significant difference was observed when the efficacy and safety of low-molecular weight heparins were compared with those of unfractionated heparin. A cost-effectiveness analysis of low-molecular weight heparins versus unfractionated heparin must be done urgently to establish more firmly the place of low-molecular weight heparins in the management of unstable angina.
Full text:
Available
Index:
IMSEAR (South-East Asia)
Main subject:
Aged
/
Female
/
Humans
/
Male
/
Heparin
/
Confidence Intervals
/
Odds Ratio
/
Randomized Controlled Trials as Topic
/
Follow-Up Studies
/
Sensitivity and Specificity
Type of study:
Controlled clinical trial
/
Diagnostic study
/
Etiology study
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Practice guideline
/
Observational study
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Prognostic study
/
Risk factors
/
Systematic reviews
Country/Region as subject:
Asia
Language:
English
Journal:
Indian heart j
Year:
2001
Type:
Article
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