Excess enoxaparin increases adverse outcomes in non-ST elevation ACS
Clinical QuestionWhat are the effects of excess and inadequate enoxaparin dosing on outcomes in patients with NSTE ACS?
Bottom LinePatients with NSTE ACS who receive higher than recommended doses of enoxaparin are at increased risk for major bleeding and in-hospital mortality. (LOE = 2b)
ReferenceLaPointe NM, Chen AY, Alexander KP, et al. Enoxaparin dosing and associated risk of in-hospital bleeding and death in patients with non-ST-segment elevation acute coronary syndromes. Arch Intern Med 2007;167:1539-44. [PMID:17646609]
Study DesignCohort (retrospective)
FundingIndustry + govt
SettingInpatient (any location)
SynopsisData from the CRUSADE registry (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines) were analyzed to determine the frequency of enoxaparin dosing that was in excess or lower than recommended (> 10 mg above or below the recommended dose) in patients with NSTE ACS and the associated risks of in-hospital major bleeding and mortality. Recommended enoxaparin dosing was 1 mg/kg every 12 hours or 1 mg/kg every 24 hours for patients with a creatinine clearance less than 30 mL/min. The cohort consisted of the 10,687 patients with NSTE ACS who had complete data. Of these patients, 18.7% received an excess dose of enoxaparin and 29.2% received a lower-than-recommended dose. Excess LMWH dosing compared to recommended dosing was associated with increased major bleeding [14.2% vs. 7.3%, number needed to harm (NNH) 15, 95% CI 11.6 - 19] and in-hospital mortality (5.6% vs. 2.4%, NNH 31, 95% CI 23 - 46). Inadequate dosing trended toward an increase in mortality (3,3% vs. 2.4%, p = 0.11)
Barry, Henry, et al., editors. "Excess Enoxaparin Increases Adverse Outcomes in non-ST Elevation ACS." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426125/all/Excess_enoxaparin_increases_adverse_outcomes_in_non_ST_elevation_ACS.
Excess enoxaparin increases adverse outcomes in non-ST elevation ACS. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426125/all/Excess_enoxaparin_increases_adverse_outcomes_in_non_ST_elevation_ACS. Accessed May 29, 2023.
Excess enoxaparin increases adverse outcomes in non-ST elevation ACS. (2019). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426125/all/Excess_enoxaparin_increases_adverse_outcomes_in_non_ST_elevation_ACS
Excess Enoxaparin Increases Adverse Outcomes in non-ST Elevation ACS [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2023 May 29]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426125/all/Excess_enoxaparin_increases_adverse_outcomes_in_non_ST_elevation_ACS.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Excess enoxaparin increases adverse outcomes in non-ST elevation ACS ID - 426125 ED - Barry,Henry, ED - Ebell,Mark H, ED - Shaughnessy,Allen F, ED - Slawson,David C, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426125/all/Excess_enoxaparin_increases_adverse_outcomes_in_non_ST_elevation_ACS PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -