Authors' objectives:

To summarise the evidence relating to the use of dalteparin and enoxaparin for unstable angina and non-Q-wave myocardial infarction.

Authors' recommendations: Short-term treatment of unstable coronary artery disease using enoxaparin: Strongly supported Short-term treatment of unstable coronary artery disease using dalteparin: Not proven Low molecular weight heparins are promising drugs, with important advantages over unfractionated heparin in terms of convenience and time saved to patients and staff. There are reasons to think that the different low molecular weight heparins have different advantages and disadvantages. The Committee therefore considered dalteparin and enoxaparin separately. Enoxaparin There were two good randomised controlled trials of enoxaparin, ESSENCE and TIMI 11B. These demonstrated an advantage in terms of the composite endpoints, both early and sustained to one year. Treatment with enoxaparin appears to be cost saving over unfractionated heparin. However, cost implications are likely to depend on local revascularisation practice (both the proportion of patients undergoing revascularisation and length of stay in hospital). Dalteparin There were no randomised controlled trials powered to compare dalteparin with unfractionated heparin. The one comparative trial did not show an advantage of dalteparin over unfractionated heparin and there was a suggestion of excess deaths in the dalteparin group (during the acute phase). However, the design and duration of study were inadequate to determine whether the small excess of early deaths was sustained in the long term. The trial evidence was therefore inadequate to address this question.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.wihrd.soton.ac.uk

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: Wessex Institute for Health Research and Development

Contact Address: Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton. SO16 7PX Tel. +44 1703 595661 Fax +44 1703 595662

Copyright: Wessex Institute for Health Research and Development (WIHRD)