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Editor's Correspondence |

New Approaches to Diagnosis and Management of Unstable Angina and Non–ST Segment Elevation Myocardial Infarction: Controversial Data—Reply

Robert A. O'Rourke, MD
Arch Intern Med. 2002;162(4):485-486. doi:.
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In the study of unstable angina by Theroux et al1 in 1993, death or myocardial infarction (MI) occurred in 3.7% of aspirin-treated patients and 0.8% of unfractionated heparin–treated patients (P = .04). Comparing unfractionated heparin and aspirin vs aspirin alone, the rate of death or MI during week 1 was 54% lower with unfractionated heparin therapy (P = .002).

In the ESSENCE trial,2 patients received enoxaparin or unfractionated heparin therapy for 2 to 8 days (median, 2.6 days). The composite end point was reduced by 16.2% at 14 days with enoxaparin (P≤.02) and sustained at 30 days. The TIMI 11B trial3 compared enoxaparin with unfractionated heparin for 3 to 6 days, with 60% of the patients receiving enoxaparin therapy or placebo for 43 days. Enoxaparin reduced events during the acute phase.

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