Objectives The purpose of this study is to evaluate hospital mortality and major bleeding rates among patients receiving low molecular weight heparin (LMWH), unfractionated heparin (UFH), or both, and to investigate whether concomitant glycoprotein (GP) llb/llla antagonists and coronary intervention affect patterns of use and outcomes with different heparins. Background With widespread use of glycoprotein (GP) llb/llla inhibitors and invasive treatments, patients with high-risk acute coronary syndrome (ACS) may have a greater bleeding risk and may not gain additional benefit from LMWHs. The purpose of this study is to evaluate hospital mortality and major bleeding rates among patients receiving LMWH, UFH, or both, and to investigate whether concomitant GP llb/llla antagonists and coronary intervention affect patterns of use and outcomes with different heparins. Methods Data were analyzed from 28445 patients with ACS; 21 287 had non-ST-segment elevation myocardial infarction or unstable angina and received LMWH or UFH. Results Fifty-one percent of patients received LMWH, 32% UFH, and 17% both. The lowest inhospital mortality and bleeding rates occurred with LMWH (2.7% and 1.8% vs UFH, 4.1 % and 2.7%; all P <.0001). After multivariable analysis, LMWH was associated with lower inhospital mortality rates in patients not treated with GP llb/llla antagonists, irrespective of whether they had a percutaneous coronary intervention (PCI) (odds ratio 0.77, 95% confidence interval 0.63-0.94 without PCI vs odds ratio 0.45, 95% confidence interval 0.21-0.98 with PCI). Excess bleeding occurred with PCI in LMWH-treated patients. Patients older than 75 years who received GP llb/llla antagonists and any antithrombotic but not PCI had an increased risk of major bleeding (LMWH 14%, UFH 8.3%). Conclusions In patients with non-ST-elevation ACS without GP llb/llla antagonists, LMWH was associated with a lower mortality rate and more bleeding episodes in PCI-treated patients than UFH; no differences occurred with GP llb/llla antagonists. Elderly patients managed medically with GP llb/llla antagonists and either heparin had a very high major bleeding risk.

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{{Explor lien
   |wiki=    Wicri/Asie
   |area=    AustralieFrV1
   |flux=    Main
   |étape=   Exploration
   |type=    RBID
   |clé=     Pascal:08-0037512
   |texte=   Interactions between heparins, glycoprotein llb/llla antagonists, and coronary intervention. The Global Registry of Acute Coronary Events (GRACE)
}}