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ISCHAEMIC HEART DISEASE
Currently the risk of a major bleeding complication following a percutaneous coronary intervention (PCI) is estimated at 4–7% (SYNERGY, REPLACE-2). Low molecular weight heparins (LMWH) offer a number if benefits over unfractionated heparin that may be able to reduce this complication rate, such as having a more stable and predictable anticoagulant dose response. Only relatively small trials to date have evaluated the use of intravenous enoxaparin on post-PCI bleeding rates, and a meta-analysis of data from these trials suggested a non-significant trend toward a reduction in major bleeding with LMWH. To investigate this possibility further the STEEPLE (Safety and Efficacy of Enoxaparin in Percutaneous Coronary Intervention Patients, an International Randomized Evaluation) trial randomly assigned 3528 patients undergoing elective PCI to receive either enoxaparin (0.5 mg or 0.75 mg per kg body weight) or unfractionated heparin adjusted for activated clotting time. The primary end point was the incidence of major or
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