© 2004 by BMJ Publishing Group & British Cardiac Society
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ISCHAEMIC HEART DISEASE
In the UK at least, low molecular weight heparin (LMWH) rather than unfractionated heparin has become the standard of care in acute coronary syndromes (ACS). In the A phase of the A to Z trial, which involved nearly 4000 patients treated with aspirin and tirofiban, the primary end point (a seven day composite of death, myocardial infarction (MI), or refractory ischaemia) occurred in 8.4% of patients assigned to receive enoxaparin compared to 9.4% in those receiving unfractionated heparin (hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.71 to 1.08). SYNERGY looked at the use of LMWH versus conventional heparin in more than 10000 patients whose ACS was also treated with an early invasive strategy. Their primary end point (30 day composite of death or MI) occurred in 14.0% of patients assigned to enoxaparin versus 14.5% receiving conventional heparin (HR 0.96, 95% CI 0.86 to 1.06). Again, the authors’ summary stated
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