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To the Editor: We are concerned that the recent studies on enoxaparin vs unfractionated heparin leave the duration of heparin treatment ill-defined for patients with acute coronary syndromes.

In the SYNERGY trial,¹ duration of drug administration was left to the judgment of the treating physician. SYNERGY was an open-label trial, and subcutaneous enoxaparin is more convenient than intravenous unfractionated heparin, which could lead to longer treatment. Therefore, it is possible that differences between enoxaparin and unfractionated heparin may be biased by longer treatment with 1 study drug. SYNERGY did not present actual duration of treatment.

Similarly, the A to Z trial² did not present its definition of treatment duration. The median time that patients received study drug was similar for both drugs: 49 hours for enoxaparin vs 48 hours for unfractionated heparin. However, time receiving enoxaparin varied much more than time receiving unfractionated heparin, as judged by the 25th . . . [Full Text of this Article]

Michael Pedrini, MD; Frank Hartig, MD; Christoph Pechlaner, MD
christoph.pechlaner@uibk.ac.at
Innsbruck University Hospital
Innsbruck, Austria

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