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Low-Molecular-Weight Heparin vs Unfractionated Heparin in Acute Coronary Syndromes
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To the Editor: The SYNERGY trial compared enoxaparin and unfractionated heparin in high-risk patients with acute coronary syndromes. In their article describing the 6-month and 1-year outcomes, Dr Mahaffey and colleagues1 report a result that was not emphasized. As indicated in Figure 2B in their article, there was a statistically significant reduction in the hazard ratio for death or myocardial infarction in the group that consistently received enoxaparin. This benefit persisted for at least 6 months after initial treatment. However, there were no differences between the groups that received enoxaparin followed by unfractionated heparin, or the reverse.
The key to this difference may be that patients treated with enoxaparin reliably and promptly achieved therapeutic levels of anticoagulation. Hull et al2 found that patients who did not attain a therapeutic activated partial thromboplastin time (aPTT) value within 24 hours after initiation of treatment for venous thromboembolic disease were more likely to . . . [Full Text of this Article]
Richard Schreiber, MD
dickie@pa.net
Lemoyne, Pa
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