Authors' objectives:

This aim of this report was to update a previous report on the effectiveness of low molecular weight heparin in comparison to unfractionated heparin for the management of unstable angina.

Authors' recommendations: - Since the release of our previous report (Anderson, 1998) there have been two meta-analyses, one randomised controlled trial and 3 guidelines published comparing low molecular weight heparin (LMWH) with unfractionated heparin (UH) in the management of unstable angina. - The studies included the LMWHs enoxaparin, dalteparin, and nadroparin and assessed the following outcomes: death, myocardial infarction (MI), revascularization, recurrent angina and risk of bleeding. - Most studies found that LMWH resulted in lower rates of death, MI, recurrent angina and vascularization than UH. - One guideline recommends LMWH over UH whereas the other guidelines advise that either should be used. - The risk of minor but not major bleeding was greater in the LMWH group compared to UH groups. We are unable to reach conclusions regarding the effectiveness of different types of LMWHs, although they may vary. The studies were of variable quality with one meta-analysis, the RCT and one guideline being of particularly high quality.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.med.monash.edu.au/healthservices/cce/evidence/

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Centre for Clinical Effectiveness

Contact Address: Monash Institute of Health Services Research, Block E, Monash Medical Centre, Locked Bag 29, Clayton, Victoria 3168, Australia. Tel: +61 3 9594 7505; Fax: +61 3 9594 7552.

Contact Name: cce@med.monash.edu.au.

Contact Email: cce@med.monash.edu.au.

Copyright: Centre for Clinical Effectiveness (CCE)