Proven outcomes in UA/NSTEMI and STEMI

Lovenox significantly reduced the incidence of the combined endpoint of death, MI, or recurrent angina versus unfractionated heparin (UFH) in UA/NSTEMI patients when administered concomitantly with aspirin.

ARR=absolute risk reduction; NNT=number needed to treat; RRR=relative risk reduction

^aThe NNT and the benefit/risk profile were not prespecified analyses in the trials and were calculated using the reported ARR results.³

Prophylaxis of ischemic complications in unstable angina and non-Q-wave myocardial infarction

Patients with recent unstable angina or non-Q-wave MI were treated with either Lovenox 1 mg/kg  subcutaneously q12h or heparin. A total of 3,107 patients, ranging in age from 25 to 94 years (median age 64 years) were treated. All patients also received aspirin 100 mg to 325 mg per day. The combined incidence of the triple endpoint of death, MI, or recurrent angina was lower with Lovenox versus heparin therapy at 14 days and sustained up to 30 days, after initiation of treatment.

Major bleeding episodes occurred in 1% of patients in each treatment group.

In ESSENCE, Lovenox provided early and long-term efficacy in ischemic events vs UFH.

The combined incidence of death or myocardial infarction at all time points was lower for Lovenox compared to standard heparin therapy, but did not achieve statistical significance.

• Urgent revascularization procedures were performed less frequently in the Lovenox group as compared to the heparin group¹
• At 30 days, major bleeds were comparable (6.5% Lovenox vs 7.0% UFH; P=NS); overall bleeding for Lovenox was higher vs UFH (18.4% vs 14.2%, respectively; P=0.001)²

Need for intervention was significantly lower with Lovenox vs UFH

Lovenox reduced the rate of the combined endpoint of recurrent myocardial infarction (MI) or death in patients with acute ST-segment elevation MI (STEMI) receiving thrombolysis and being managed medically or with percutaneous coronary intervention (PCI).¹

Patients with acute ST-segment elevation myocardial infarction (STEMI) who were to be hospitalized within 6 hours of onset and were eligible to receive fibrinolytic therapy were randomized in a 1:1 ratio to receive either Lovenox or unfractionated heparin (UFH). All patients were treated with aspirin for a minimum of 30 days. A total of 20,479 patients, mean age 60 years, were randomized. Rates of major hemorrhage at 30 days were 2.1% and 1.4% in the Lovenox and UFH groups, respectively.

All patients should receive ASA as soon as they are identified as having STEMI, and maintained with 75 mg to 325 mg once daily, unless contraindicated.

The only adverse reaction that occurred at a rate of at least 0.5% in the Lovenox group was thrombocytopenia (1.5%).

2013 ACCF/AHA Guidelines on the management of ST-elevation MI recommend the use of enoxaparin as adjunctive anticoagulant therapy with fibrinolysis when PCI is not possible and when PCI is delayed.⁸