Expensive, New Blood Thinner No Better Than Heparin

A newer blood thinner might not be an improvement over an old standby—hep-arin—at treating patients having heart attacks or chest pain. Although the newer drug, enoxaparin (Lovenox®, Aventis), is more convenient to use than heparin, it also caused modest increases in bleeding.

Heparin has been used for several decades to treat blood clots in heart patients.

The FDA approved enoxaparin in the late 1990s for use in patients with cardiac disease. It is one of several newer, more potent heparin varieties with a lower molecular weight. Although it costs about $100 a day, several times more than heparin, enoxaparin supporters say that it is ultimately the same in cost or cheaper because it is easier to administer; it can be delivered by injection rather than a continuous intravenous drip, and no blood tests are required to monitor its efficacy.

Investigators at Duke Clinical Research Institute in Durham, North Carolina, and at other institutions conducted two major studies involving nearly 14,000 patients. One study was funded by Aven-tis. Earlier, smaller studies had favored enoxaparin over heparin. Approximately 30% of heart patients receive enoxaparin.
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The larger study, which involved approximately 10,000 patients, found that 14% of those who received enoxaparin died or experienced repeated heart attacks in the 30 days afterward; 14.5% of those who received heparin died or experienced repeated heart attacks. However, patients receiving enoxaparin had more bleeding—usually at the catheter site in the groin—but rarely enough to cause complications.

The smaller study involved almost 4,000 patients who received other drugs commonly given to heart patients. No difference in effectiveness was observed between enoxaparin and heparin.

A third study, also funded by Aventis, analyzed results from six studies, including the two new ones and found that enoxaparin was more effective than hep-arin. However, other physicians questioned the findings because the analysis included older data from a time when treatment practices were different.