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Non-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events.
Eur Heart J. 2005 Nov; 26(21):2285-93.EH

Abstract

AIMS

To determine whether low-molecular-weight heparin (LMWH)+glycoprotein (GP) IIb/IIIa inhibitors provide greater benefit than unfractionated heparin (UFH)+GP IIb/IIIa inhibitors, irrespective of renal status.

METHODS AND RESULTS

Patients in the Global Registry of Acute Coronary Events (GRACE) were divided into three groups according to creatinine clearance (CrCl): normal renal function (CrCl >60 mL/min), moderate renal dysfunction (30<CrCl< or =60 mL/min), and severe (CrCl< or =30 mL/min) renal dysfunction. Data were analysed from 11 881 patients with acute coronary syndrome (ACS). Patients with moderate (n=3705) or severe (n=982) renal dysfunction were at higher risk of adverse outcomes than those with normal renal function. Decreasing CrCl was an independent predictor of mortality at 30 days and in-hospital major bleeding. LMWH+GP IIb/IIIa inhibitors were used significantly less frequently in patients with severe (2.0%) or moderate (3.1%) renal dysfunction than in those with normal function (3.9%, P=0.0056). LMWH alone was more beneficial than UFH alone, irrespective of renal status. LMWH alone was an independent predictor of 30 day survival [odds ratio (OR) 0.56; 95% confidence interval (CI) 0.43-0.73] and lower risk of in-hospital bleeding (OR 0.66; 95% CI 0.48-0.92). Bleeding rates were significantly lower with LMWH+GP IIb/IIIa inhibitors than those with UFH+GP IIb/IIIa inhibitors. Use of UFH+GP IIb/IIIa inhibitors was an independent predictor of bleeding (OR 2.02; 95% CI 1.42-2.90) compared with UFH alone.

CONCLUSION

In patients with renal dysfunction and non-ST-segment elevation ACS, bleeding complications are more frequent and outcomes appear worse in individuals treated with UFH compared with LMWH. Combination therapy with LMWH and GP IIb/IIIa inhibitors appears to be better tolerated than with UFH and GP IIb/IIIa inhibitors.

Authors+Show Affiliations

Department of Cardiology, Centre Hôpital Pitié-Salpêtrière, Bureau 2-236, 47, Boulevard de l'Hôpital, 75013 Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15932908

Citation

Collet, Jean-Philippe, et al. "Non-ST-segment Elevation Acute Coronary Syndrome in Patients With Renal Dysfunction: Benefit of Low-molecular-weight Heparin Alone or With Glycoprotein IIb/IIIa Inhibitors On Outcomes. the Global Registry of Acute Coronary Events." European Heart Journal, vol. 26, no. 21, 2005, pp. 2285-93.
Collet JP, Montalescot G, Agnelli G, et al. Non-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events. Eur Heart J. 2005;26(21):2285-93.
Collet, J. P., Montalescot, G., Agnelli, G., Van de Werf, F., Gurfinkel, E. P., López-Sendón, J., Laufenberg, C. V., Klutman, M., Gowda, N., & Gulba, D. (2005). Non-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events. European Heart Journal, 26(21), 2285-93.
Collet JP, et al. Non-ST-segment Elevation Acute Coronary Syndrome in Patients With Renal Dysfunction: Benefit of Low-molecular-weight Heparin Alone or With Glycoprotein IIb/IIIa Inhibitors On Outcomes. the Global Registry of Acute Coronary Events. Eur Heart J. 2005;26(21):2285-93. PubMed PMID: 15932908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events. AU - Collet,Jean-Philippe, AU - Montalescot,Gilles, AU - Agnelli,Giancarlo, AU - Van de Werf,Frans, AU - Gurfinkel,Enrique P, AU - López-Sendón,Jose, AU - Laufenberg,Christopher V, AU - Klutman,Martin, AU - Gowda,Neelam, AU - Gulba,Dietrich, AU - ,, Y1 - 2005/06/02/ PY - 2005/6/4/pubmed PY - 2006/5/13/medline PY - 2005/6/4/entrez SP - 2285 EP - 93 JF - European heart journal JO - Eur Heart J VL - 26 IS - 21 N2 - AIMS: To determine whether low-molecular-weight heparin (LMWH)+glycoprotein (GP) IIb/IIIa inhibitors provide greater benefit than unfractionated heparin (UFH)+GP IIb/IIIa inhibitors, irrespective of renal status. METHODS AND RESULTS: Patients in the Global Registry of Acute Coronary Events (GRACE) were divided into three groups according to creatinine clearance (CrCl): normal renal function (CrCl >60 mL/min), moderate renal dysfunction (30<CrCl< or =60 mL/min), and severe (CrCl< or =30 mL/min) renal dysfunction. Data were analysed from 11 881 patients with acute coronary syndrome (ACS). Patients with moderate (n=3705) or severe (n=982) renal dysfunction were at higher risk of adverse outcomes than those with normal renal function. Decreasing CrCl was an independent predictor of mortality at 30 days and in-hospital major bleeding. LMWH+GP IIb/IIIa inhibitors were used significantly less frequently in patients with severe (2.0%) or moderate (3.1%) renal dysfunction than in those with normal function (3.9%, P=0.0056). LMWH alone was more beneficial than UFH alone, irrespective of renal status. LMWH alone was an independent predictor of 30 day survival [odds ratio (OR) 0.56; 95% confidence interval (CI) 0.43-0.73] and lower risk of in-hospital bleeding (OR 0.66; 95% CI 0.48-0.92). Bleeding rates were significantly lower with LMWH+GP IIb/IIIa inhibitors than those with UFH+GP IIb/IIIa inhibitors. Use of UFH+GP IIb/IIIa inhibitors was an independent predictor of bleeding (OR 2.02; 95% CI 1.42-2.90) compared with UFH alone. CONCLUSION: In patients with renal dysfunction and non-ST-segment elevation ACS, bleeding complications are more frequent and outcomes appear worse in individuals treated with UFH compared with LMWH. Combination therapy with LMWH and GP IIb/IIIa inhibitors appears to be better tolerated than with UFH and GP IIb/IIIa inhibitors. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/15932908/Non_ST_segment_elevation_acute_coronary_syndrome_in_patients_with_renal_dysfunction:_benefit_of_low_molecular_weight_heparin_alone_or_with_glycoprotein_IIb/IIIa_inhibitors_on_outcomes__The_Global_Registry_of_Acute_Coronary_Events_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehi337 DB - PRIME DP - Unbound Medicine ER -