Jerome Premmereur - Academia.edu (original) (raw)

Papers by Jerome Premmereur

46th Annual Meeting, Oct 26, 2008

American Journal of Obstetrics and Gynecology, 2011

RESULTS: 910 women were included. BF continuation dropped markedly as BMI increased (normal 83.6%... more RESULTS: 910 women were included. BF continuation dropped markedly as BMI increased (normal 83.6%, overweight 72.0%, class 1 60.8%, class 2 56.4% and class 35.6%; pϽ0.001)(Figure 1). Breastfeeding initiation follows a similar yet attenuated pattern. Normal weight women without depressed mood breastfed 85.9% compared to 61.8% of obese women. Depressed mood negatively impacted the frequency of BF postpartum in both normal and obese women (69.6% and 45.2%, respectively) (Table 1). Body image was not associated with BF. Multivariate analysis revealed, women who screened positive for depression, were overweight or obese were 42%, 50% and 69% less likely to continue BF by 6-8 weeks postpartum. The interaction of depressed mood and BMI on BF discontinuation was additive. CONCLUSIONS: Overweight, obesity and depressed mood are associated with decreased BF initiation and continuation. The effects of obesity and depressed mood on BF are additive.

American Journal of Cardiology, Dec 1, 1999

This pilot study was designed to determine whether the low molecular weight heparin, enoxaparin, ... more This pilot study was designed to determine whether the low molecular weight heparin, enoxaparin, could be used for elective percutaneous coronary intervention (PCI) to provide antithrombotic effects without the full systemic anticoagulation that occurs with the use of unfractionated heparin. Sixty patients were randomized to receive intravenous enoxaparin (1 mg/kg bolus dose) or unfractionated heparin at the time of coronary intervention. Laboratory testing was performed at baseline, 5 minutes, and 4 hours after study drug to test if a single bolus dose of intravenous enoxaparin can consistently achieve therapeutic antithrombotic effect, thus eliminating the need for multiple doses of heparin and closely monitoring levels of anticoagulation during PCI. Thirty percent of patients who received unfractionated heparin required a second bolus of intravenous heparin to achieve the target-activated clotting time of 300 seconds before PCI. Enoxaparin showed antithrombotic properties comparable to that of unfractionated heparin as measured by anti-Xa levels, with less inhibition of thrombin (factor IIa) at the time points measured (p <0.0001). Angioplasty success rates, in-hospital ischemia, bleeding, and vascular complications were similar in both groups. Thus, intravenous enoxaparin has predictable and effective antithrombotic effects during elective PCI. Although the level of anticoagulation attained with enoxaparin is significantly lower than that after unfractionated heparin, no increase in ischemic complications were noted. The use of a single bolus of intravenous enoxaparin, without the need for measuring the activated clotting time or titrating heparin anticoagulation, has the potential for simplifying the performance and perhaps enhancing the safety of PCI. ᮊ1999 by Excerpta Medica, Inc.

Revue française de psychosomatique, Feb 3, 2023

Une nouvelle vision des équilibres entre le psychisme et le somatique dans une intégration au mon... more Une nouvelle vision des équilibres entre le psychisme et le somatique dans une intégration au monde extérieurs se dégage à la lumière des avancées scientifiques en biologie moléculaire et applications médicales. La cohérence de ces découvertes avec la philosophie de Baruck Spinoza permet de repenser les sciences du vivant dans une perspective éthologique, c’est-à-dire une nouvelle approche des comportements humains dans leur milieu naturel. L’auteur se propose de revoir 4 exemples de cet usage biologique de la philosophie de Spinoza et de ses conséquences.

Cardiovascular Research, 1994

American Journal of Obstetrics and Gynecology, 2011

RESULTS: 910 women were included. BF continuation dropped markedly as BMI increased (normal 83.6%... more RESULTS: 910 women were included. BF continuation dropped markedly as BMI increased (normal 83.6%, overweight 72.0%, class 1 60.8%, class 2 56.4% and class 35.6%; pϽ0.001)(Figure 1). Breastfeeding initiation follows a similar yet attenuated pattern. Normal weight women without depressed mood breastfed 85.9% compared to 61.8% of obese women. Depressed mood negatively impacted the frequency of BF postpartum in both normal and obese women (69.6% and 45.2%, respectively) (Table 1). Body image was not associated with BF. Multivariate analysis revealed, women who screened positive for depression, were overweight or obese were 42%, 50% and 69% less likely to continue BF by 6-8 weeks postpartum. The interaction of depressed mood and BMI on BF discontinuation was additive. CONCLUSIONS: Overweight, obesity and depressed mood are associated with decreased BF initiation and continuation. The effects of obesity and depressed mood on BF are additive.

The American Journal of Cardiology, 1999

This pilot study was designed to determine whether the low molecular weight heparin, enoxaparin, ... more This pilot study was designed to determine whether the low molecular weight heparin, enoxaparin, could be used for elective percutaneous coronary intervention (PCI) to provide antithrombotic effects without the full systemic anticoagulation that occurs with the use of unfractionated heparin. Sixty patients were randomized to receive intravenous enoxaparin (1 mg/kg bolus dose) or unfractionated heparin at the time of coronary intervention. Laboratory testing was performed at baseline, 5 minutes, and 4 hours after study drug to test if a single bolus dose of intravenous enoxaparin can consistently achieve therapeutic antithrombotic effect, thus eliminating the need for multiple doses of heparin and closely monitoring levels of anticoagulation during PCI. Thirty percent of patients who received unfractionated heparin required a second bolus of intravenous heparin to achieve the target-activated clotting time of 300 seconds before PCI. Enoxaparin showed antithrombotic properties comparable to that of unfractionated heparin as measured by anti-Xa levels, with less inhibition of thrombin (factor IIa) at the time points measured (p <0.0001). Angioplasty success rates, in-hospital ischemia, bleeding, and vascular complications were similar in both groups. Thus, intravenous enoxaparin has predictable and effective antithrombotic effects during elective PCI. Although the level of anticoagulation attained with enoxaparin is significantly lower than that after unfractionated heparin, no increase in ischemic complications were noted. The use of a single bolus of intravenous enoxaparin, without the need for measuring the activated clotting time or titrating heparin anticoagulation, has the potential for simplifying the performance and perhaps enhancing the safety of PCI. ᮊ1999 by Excerpta Medica, Inc.

Air Medical Journal, 1998

The New England Journal of Medicine, Aug 14, 1997

Background Antithrombotic therapy with heparin plus aspirin reduces the rate of ischemic events i... more Background Antithrombotic therapy with heparin plus aspirin reduces the rate of ischemic events in patients with unstable coronary artery disease. Lowmolecular-weight heparin has a more predictable anticoagulant effect than standard unfractionated heparin, is easier to administer, and does not require monitoring. Methods In a double-blind, placebo-controlled study, we randomly assigned 3171 patients with angina at rest or non-Q-wave myocardial infarction to receive either 1 mg of enoxaparin (low-molecular-weight heparin) per kilogram of body weight, administered subcutaneously twice daily, or continuous intravenous unfractionated heparin. Therapy was continued for a minimum of 48 hours to a maximum of 8 days, and we collected data on important coronary end points over a period of 30 days. Results At 14 days the risk of death, myocardial infarction, or recurrent angina was significantly lower in the patients assigned to enoxaparin than in those assigned to unfractionated heparin (16.6 percent vs. 19.8 percent, P ϭ 0.019). At 30 days, the risk of this composite end point remained significantly lower in the enoxaparin group (19.8 percent vs. 23.3 percent, P ϭ 0.016). The need for revascularization procedures at 30 days was also significantly less frequent in the patients assigned to enoxaparin (27.0 percent vs. 32.2 percent, P ϭ 0.001). The 30-day incidence of major bleeding complications was 6.5 percent in the enoxaparin group and 7.0 percent in the unfractionated-heparin group, but the incidence of bleeding overall was significantly higher in the enoxaparin group (18.4 percent vs. 14.2 percent, P ϭ 0.001), primarily because of ecchymoses at injection sites. Conclusions Antithrombotic therapy with enoxaparin plus aspirin was more effective than unfractionated heparin plus aspirin in reducing the incidence of ischemic events in patients with unstable angina or non-Q-wave myocardial infarction in the early phase. This benefit of enoxaparin was achieved with an increase in minor but not in major bleeding. (N Engl

The online version of this article, along with updated information and services, is located on the

Cardiovascular Drugs and Therapy, 1998

Circulation, 1999

Background —Two phase III trials of enoxaparin for unstable angina/non–Q-wave myocardial infarcti... more Background —Two phase III trials of enoxaparin for unstable angina/non–Q-wave myocardial infarction have shown it to be superior to unfractionated heparin for preventing a composite of death and cardiac ischemic events. A prospectively planned meta-analysis was performed to provide a more precise estimate of the effects of enoxaparin on multiple end points. Methods and Results —Event rates for death, the composite end points of death/nonfatal myocardial infarction and death/nonfatal myocardial infarction/urgent revascularization, and major hemorrhage were extracted from the TIMI 11B and ESSENCE databases. Treatment effects at days 2, 8, 14, and 43 were expressed as the OR (and 95% CI) for enoxaparin versus unfractionated heparin. All heterogeneity tests for efficacy end points were negative, which suggests comparability of the findings in TIMI 11B and ESSENCE. Enoxaparin was associated with a 20% reduction in death and serious cardiac ischemic events that appeared within the first f...

Circulation, 1999

Background —Low-molecular-weight heparins are attractive alternatives to unfractionated heparin (... more Background —Low-molecular-weight heparins are attractive alternatives to unfractionated heparin (UFH) for management of unstable angina/non–Q-wave myocardial infarction (UA/NQMI). Methods and Results —Patients (n=3910) with UA/NQMI were randomized to intravenous UFH for ≥3 days followed by subcutaneous placebo injections or uninterrupted antithrombin therapy with enoxaparin during both the acute phase (initial 30 mg intravenous bolus followed by injections of 1.0 mg/kg every 12 hours) and outpatient phase (injections every 12 hours of 40 mg for patients weighing <65 kg and 60 mg for those weighing ≥65 kg). The primary end point (death, myocardial infarction, or urgent revascularization) occurred by 8 days in 14.5% of patients in the UFH group and 12.4% of patients in the enoxaparin group (OR 0.83; 95% CI 0.69 to 1.00; P =0.048) and by 43 days in 19.7% of the UFH group and 17.3% of the enoxaparin group (OR 0.85; 95% CI 0.72 to 1.00; P =0.048). During the first 72 hours and also th...

The American Journal of Cardiology, 2001

The American Journal of Cardiology, 1998

for the ESSENCE Study Group Combination antithrombotic therapy with heparin plus aspirin decrease... more for the ESSENCE Study Group Combination antithrombotic therapy with heparin plus aspirin decreases the risk of recurrent ischemic events in patients with acute coronary syndromes without persistent ST-segment elevation. Compared with standard unfractionated heparin, low-molecular-weight heparin (LMWH) has a more predictable antithrombotic effect, is easier to administer, and does not require coagulation monitoring. At 176 hospitals in 3 continents, 3,171 patients with rest unstable angina or non-Q-wave myocardial infarction were randomly assigned to either enoxaparin (a LMWH), 1 mg/kg twice daily subcutaneously, or to continuous intravenous unfractionated heparin, for a minimum of 48 hours to a maximum of 8 days. Trial medication was administered in a doubleblind, placebo-controlled fashion. At 14 days, the primary endpoint, the composite risk of death, myocardial infarction, or recurrent angina with electrocardiographic changes or prompting intervention, was significantly lower in patients assigned to enoxaparin compared with heparin (16.6% vs 19.8%; odds ratio [OR] 1.24; 95% confidence interval [CI] 1.04-1.49; p ‫؍‬ 0.019). At 30 days, the composite risk of death, myocardial infarction, or recurrent angina remained significantly lower in the enoxaparin group compared with the unfractionated heparin group (19.8% vs 23.3%, OR 1.23; 95% CI 1.0-1.46, p ‫؍‬ 0.016). The rate of revascularization procedures at 30 days was also significantly lower in patients assigned to enoxaparin (27.1% vs 32.2%, p ‫؍‬ 0.001). The 30-day incidence of major bleeding complication was 6.5% versus 7.0% (p ‫؍‬ not significant), but the incidence of minor bleeding was significantly higher in the enoxaparin group (13.8% vs 8.8%, p <0.001) due primarily to injection-site ecchymosis. Thus, combination antithrombotic therapy with enoxaparin plus aspirin is more effective than unfractionated heparin plus aspirin in decreasing ischemic outcomes in patients with unstable angina or non-Q-wave myocardial infarction in the early (30 days) phase. The lower recurrent ischemic event rate seen with the LMWH, enoxaparin, is achieved without an increase in major bleeding, but with an increase in minor bleeding complications due mainly to injection-site ecchymosis. ᮊ1998 by Excerpta Medica, Inc.

Journal of Thrombosis and Thrombolysis, 1997

Antithrombotic therapy reduces the risk of recurrent ischemic events in patients with unstable an... more Antithrombotic therapy reduces the risk of recurrent ischemic events in patients with unstable angina. The primary aim of the ESSENCE trial is to evaluate the efficacy of enoxaparin (low molecular weight heparin) versus unfractionated heparin, plus aspirin, in patients with rest angina or non-Q-wave infarction. This is a randomized, double-blind, placebo-controlled study of 3180 patients comparing enoxaparin, 1 mg/kg sc

46th Annual Meeting, Oct 26, 2008

American Journal of Obstetrics and Gynecology, 2011

RESULTS: 910 women were included. BF continuation dropped markedly as BMI increased (normal 83.6%... more RESULTS: 910 women were included. BF continuation dropped markedly as BMI increased (normal 83.6%, overweight 72.0%, class 1 60.8%, class 2 56.4% and class 35.6%; pϽ0.001)(Figure 1). Breastfeeding initiation follows a similar yet attenuated pattern. Normal weight women without depressed mood breastfed 85.9% compared to 61.8% of obese women. Depressed mood negatively impacted the frequency of BF postpartum in both normal and obese women (69.6% and 45.2%, respectively) (Table 1). Body image was not associated with BF. Multivariate analysis revealed, women who screened positive for depression, were overweight or obese were 42%, 50% and 69% less likely to continue BF by 6-8 weeks postpartum. The interaction of depressed mood and BMI on BF discontinuation was additive. CONCLUSIONS: Overweight, obesity and depressed mood are associated with decreased BF initiation and continuation. The effects of obesity and depressed mood on BF are additive.

American Journal of Cardiology, Dec 1, 1999

This pilot study was designed to determine whether the low molecular weight heparin, enoxaparin, ... more This pilot study was designed to determine whether the low molecular weight heparin, enoxaparin, could be used for elective percutaneous coronary intervention (PCI) to provide antithrombotic effects without the full systemic anticoagulation that occurs with the use of unfractionated heparin. Sixty patients were randomized to receive intravenous enoxaparin (1 mg/kg bolus dose) or unfractionated heparin at the time of coronary intervention. Laboratory testing was performed at baseline, 5 minutes, and 4 hours after study drug to test if a single bolus dose of intravenous enoxaparin can consistently achieve therapeutic antithrombotic effect, thus eliminating the need for multiple doses of heparin and closely monitoring levels of anticoagulation during PCI. Thirty percent of patients who received unfractionated heparin required a second bolus of intravenous heparin to achieve the target-activated clotting time of 300 seconds before PCI. Enoxaparin showed antithrombotic properties comparable to that of unfractionated heparin as measured by anti-Xa levels, with less inhibition of thrombin (factor IIa) at the time points measured (p <0.0001). Angioplasty success rates, in-hospital ischemia, bleeding, and vascular complications were similar in both groups. Thus, intravenous enoxaparin has predictable and effective antithrombotic effects during elective PCI. Although the level of anticoagulation attained with enoxaparin is significantly lower than that after unfractionated heparin, no increase in ischemic complications were noted. The use of a single bolus of intravenous enoxaparin, without the need for measuring the activated clotting time or titrating heparin anticoagulation, has the potential for simplifying the performance and perhaps enhancing the safety of PCI. ᮊ1999 by Excerpta Medica, Inc.

Revue française de psychosomatique, Feb 3, 2023

Une nouvelle vision des équilibres entre le psychisme et le somatique dans une intégration au mon... more Une nouvelle vision des équilibres entre le psychisme et le somatique dans une intégration au monde extérieurs se dégage à la lumière des avancées scientifiques en biologie moléculaire et applications médicales. La cohérence de ces découvertes avec la philosophie de Baruck Spinoza permet de repenser les sciences du vivant dans une perspective éthologique, c’est-à-dire une nouvelle approche des comportements humains dans leur milieu naturel. L’auteur se propose de revoir 4 exemples de cet usage biologique de la philosophie de Spinoza et de ses conséquences.

Cardiovascular Research, 1994

American Journal of Obstetrics and Gynecology, 2011

RESULTS: 910 women were included. BF continuation dropped markedly as BMI increased (normal 83.6%... more RESULTS: 910 women were included. BF continuation dropped markedly as BMI increased (normal 83.6%, overweight 72.0%, class 1 60.8%, class 2 56.4% and class 35.6%; pϽ0.001)(Figure 1). Breastfeeding initiation follows a similar yet attenuated pattern. Normal weight women without depressed mood breastfed 85.9% compared to 61.8% of obese women. Depressed mood negatively impacted the frequency of BF postpartum in both normal and obese women (69.6% and 45.2%, respectively) (Table 1). Body image was not associated with BF. Multivariate analysis revealed, women who screened positive for depression, were overweight or obese were 42%, 50% and 69% less likely to continue BF by 6-8 weeks postpartum. The interaction of depressed mood and BMI on BF discontinuation was additive. CONCLUSIONS: Overweight, obesity and depressed mood are associated with decreased BF initiation and continuation. The effects of obesity and depressed mood on BF are additive.

The American Journal of Cardiology, 1999

This pilot study was designed to determine whether the low molecular weight heparin, enoxaparin, ... more This pilot study was designed to determine whether the low molecular weight heparin, enoxaparin, could be used for elective percutaneous coronary intervention (PCI) to provide antithrombotic effects without the full systemic anticoagulation that occurs with the use of unfractionated heparin. Sixty patients were randomized to receive intravenous enoxaparin (1 mg/kg bolus dose) or unfractionated heparin at the time of coronary intervention. Laboratory testing was performed at baseline, 5 minutes, and 4 hours after study drug to test if a single bolus dose of intravenous enoxaparin can consistently achieve therapeutic antithrombotic effect, thus eliminating the need for multiple doses of heparin and closely monitoring levels of anticoagulation during PCI. Thirty percent of patients who received unfractionated heparin required a second bolus of intravenous heparin to achieve the target-activated clotting time of 300 seconds before PCI. Enoxaparin showed antithrombotic properties comparable to that of unfractionated heparin as measured by anti-Xa levels, with less inhibition of thrombin (factor IIa) at the time points measured (p <0.0001). Angioplasty success rates, in-hospital ischemia, bleeding, and vascular complications were similar in both groups. Thus, intravenous enoxaparin has predictable and effective antithrombotic effects during elective PCI. Although the level of anticoagulation attained with enoxaparin is significantly lower than that after unfractionated heparin, no increase in ischemic complications were noted. The use of a single bolus of intravenous enoxaparin, without the need for measuring the activated clotting time or titrating heparin anticoagulation, has the potential for simplifying the performance and perhaps enhancing the safety of PCI. ᮊ1999 by Excerpta Medica, Inc.

Air Medical Journal, 1998

The New England Journal of Medicine, Aug 14, 1997

Background Antithrombotic therapy with heparin plus aspirin reduces the rate of ischemic events i... more Background Antithrombotic therapy with heparin plus aspirin reduces the rate of ischemic events in patients with unstable coronary artery disease. Lowmolecular-weight heparin has a more predictable anticoagulant effect than standard unfractionated heparin, is easier to administer, and does not require monitoring. Methods In a double-blind, placebo-controlled study, we randomly assigned 3171 patients with angina at rest or non-Q-wave myocardial infarction to receive either 1 mg of enoxaparin (low-molecular-weight heparin) per kilogram of body weight, administered subcutaneously twice daily, or continuous intravenous unfractionated heparin. Therapy was continued for a minimum of 48 hours to a maximum of 8 days, and we collected data on important coronary end points over a period of 30 days. Results At 14 days the risk of death, myocardial infarction, or recurrent angina was significantly lower in the patients assigned to enoxaparin than in those assigned to unfractionated heparin (16.6 percent vs. 19.8 percent, P ϭ 0.019). At 30 days, the risk of this composite end point remained significantly lower in the enoxaparin group (19.8 percent vs. 23.3 percent, P ϭ 0.016). The need for revascularization procedures at 30 days was also significantly less frequent in the patients assigned to enoxaparin (27.0 percent vs. 32.2 percent, P ϭ 0.001). The 30-day incidence of major bleeding complications was 6.5 percent in the enoxaparin group and 7.0 percent in the unfractionated-heparin group, but the incidence of bleeding overall was significantly higher in the enoxaparin group (18.4 percent vs. 14.2 percent, P ϭ 0.001), primarily because of ecchymoses at injection sites. Conclusions Antithrombotic therapy with enoxaparin plus aspirin was more effective than unfractionated heparin plus aspirin in reducing the incidence of ischemic events in patients with unstable angina or non-Q-wave myocardial infarction in the early phase. This benefit of enoxaparin was achieved with an increase in minor but not in major bleeding. (N Engl

The online version of this article, along with updated information and services, is located on the

Cardiovascular Drugs and Therapy, 1998

Circulation, 1999

Background —Two phase III trials of enoxaparin for unstable angina/non–Q-wave myocardial infarcti... more Background —Two phase III trials of enoxaparin for unstable angina/non–Q-wave myocardial infarction have shown it to be superior to unfractionated heparin for preventing a composite of death and cardiac ischemic events. A prospectively planned meta-analysis was performed to provide a more precise estimate of the effects of enoxaparin on multiple end points. Methods and Results —Event rates for death, the composite end points of death/nonfatal myocardial infarction and death/nonfatal myocardial infarction/urgent revascularization, and major hemorrhage were extracted from the TIMI 11B and ESSENCE databases. Treatment effects at days 2, 8, 14, and 43 were expressed as the OR (and 95% CI) for enoxaparin versus unfractionated heparin. All heterogeneity tests for efficacy end points were negative, which suggests comparability of the findings in TIMI 11B and ESSENCE. Enoxaparin was associated with a 20% reduction in death and serious cardiac ischemic events that appeared within the first f...

Circulation, 1999

Background —Low-molecular-weight heparins are attractive alternatives to unfractionated heparin (... more Background —Low-molecular-weight heparins are attractive alternatives to unfractionated heparin (UFH) for management of unstable angina/non–Q-wave myocardial infarction (UA/NQMI). Methods and Results —Patients (n=3910) with UA/NQMI were randomized to intravenous UFH for ≥3 days followed by subcutaneous placebo injections or uninterrupted antithrombin therapy with enoxaparin during both the acute phase (initial 30 mg intravenous bolus followed by injections of 1.0 mg/kg every 12 hours) and outpatient phase (injections every 12 hours of 40 mg for patients weighing <65 kg and 60 mg for those weighing ≥65 kg). The primary end point (death, myocardial infarction, or urgent revascularization) occurred by 8 days in 14.5% of patients in the UFH group and 12.4% of patients in the enoxaparin group (OR 0.83; 95% CI 0.69 to 1.00; P =0.048) and by 43 days in 19.7% of the UFH group and 17.3% of the enoxaparin group (OR 0.85; 95% CI 0.72 to 1.00; P =0.048). During the first 72 hours and also th...

The American Journal of Cardiology, 2001

The American Journal of Cardiology, 1998

for the ESSENCE Study Group Combination antithrombotic therapy with heparin plus aspirin decrease... more for the ESSENCE Study Group Combination antithrombotic therapy with heparin plus aspirin decreases the risk of recurrent ischemic events in patients with acute coronary syndromes without persistent ST-segment elevation. Compared with standard unfractionated heparin, low-molecular-weight heparin (LMWH) has a more predictable antithrombotic effect, is easier to administer, and does not require coagulation monitoring. At 176 hospitals in 3 continents, 3,171 patients with rest unstable angina or non-Q-wave myocardial infarction were randomly assigned to either enoxaparin (a LMWH), 1 mg/kg twice daily subcutaneously, or to continuous intravenous unfractionated heparin, for a minimum of 48 hours to a maximum of 8 days. Trial medication was administered in a doubleblind, placebo-controlled fashion. At 14 days, the primary endpoint, the composite risk of death, myocardial infarction, or recurrent angina with electrocardiographic changes or prompting intervention, was significantly lower in patients assigned to enoxaparin compared with heparin (16.6% vs 19.8%; odds ratio [OR] 1.24; 95% confidence interval [CI] 1.04-1.49; p ‫؍‬ 0.019). At 30 days, the composite risk of death, myocardial infarction, or recurrent angina remained significantly lower in the enoxaparin group compared with the unfractionated heparin group (19.8% vs 23.3%, OR 1.23; 95% CI 1.0-1.46, p ‫؍‬ 0.016). The rate of revascularization procedures at 30 days was also significantly lower in patients assigned to enoxaparin (27.1% vs 32.2%, p ‫؍‬ 0.001). The 30-day incidence of major bleeding complication was 6.5% versus 7.0% (p ‫؍‬ not significant), but the incidence of minor bleeding was significantly higher in the enoxaparin group (13.8% vs 8.8%, p <0.001) due primarily to injection-site ecchymosis. Thus, combination antithrombotic therapy with enoxaparin plus aspirin is more effective than unfractionated heparin plus aspirin in decreasing ischemic outcomes in patients with unstable angina or non-Q-wave myocardial infarction in the early (30 days) phase. The lower recurrent ischemic event rate seen with the LMWH, enoxaparin, is achieved without an increase in major bleeding, but with an increase in minor bleeding complications due mainly to injection-site ecchymosis. ᮊ1998 by Excerpta Medica, Inc.

Journal of Thrombosis and Thrombolysis, 1997

Antithrombotic therapy reduces the risk of recurrent ischemic events in patients with unstable an... more Antithrombotic therapy reduces the risk of recurrent ischemic events in patients with unstable angina. The primary aim of the ESSENCE trial is to evaluate the efficacy of enoxaparin (low molecular weight heparin) versus unfractionated heparin, plus aspirin, in patients with rest angina or non-Q-wave infarction. This is a randomized, double-blind, placebo-controlled study of 3180 patients comparing enoxaparin, 1 mg/kg sc