Bleeding Risk Factors with Enoxaparin for Patients with NSTEMI/UA in HUKM

Low-molecular-weight heparins (LMWHs) are antithrombotic agents utilised in the treatment of acute coronary syndromes. They have been shown to be more effective than unfra ctionated heparins (UFHS) in reducing ischeamic events. which include death. myocardial inf arction (Mf) and urgent revascularisation. Enoxaparin is one ofthe products ofLMWHs. Its safety and efficacy has been proven in the ESSENCE and TIMl /lB studies. This study was carried out to identify risk factors that may affect bleeding complications associated with the use of enoxaparin for non-sr-elevation Ml (NSTEMl) or unstable angina (UA) in Universiti Kebangsaan Malaysia Hospital (HUKM). This observational, longitudinal study was conducted on patients who were admitted to the Coronary Care Unit (ccu), Coronary Rehabilitation Ward (CRW), Medical I and Medical 2 wards at HUKM and initiated on enoxaparin for NSTEMJluAfrom 22nd ofMarch until Tl ofApril 2004. A total of40 patients were included in the study with median age of65 years, male tofemale ratio of 3:1, diagnosed with NSTEMl (55%) and UA (45%).45% ofpatients developed an episode ofbleeding and among them 83.3% (15 patients) characterised by haematuria. Higher percentages of women (80%) and those with creatinine clearance of 30mllmin (100%) had incidence of bleeding as compared to men (50%) and those with creatinine clearance ≥30 ml/min, respectively (p 0.05 for both parameters). Age, enoxaparin dose and duration of therapy, smoking and concomitant aspirinlticlopidine therapy did not significantly affect the incidence of bleeding. In conclusion, renal impairment and gender were associated with bleeding in relation with the use ofenoxaparin that may require dose adjustments.