Conclusions In patients with unstable coronary artery disease, an invasive strategy was more effective in reducing the composite outcome of death and MI than a noninvasive strategy. At 6 months, dalteparin did not reduce death and MI more than did placebo. It is not clear, however, whether an increased incidence of major bleeding in patients receiving dalteparin contributed to the decreasing treatment effect between 6 weeks and 3 months. Although some differences may result from the trial design, subtle differences may also be present among the LMWHs. It is not clear whether LMWH is more effective than standard unfractionated heparin in all groups of patients.
More work is needed to compare the different types of heparins available.
It is also unclear whether the serious adverse event rates were significantly different between invasive and noninvasive groups and between dalteparin and placebo groups. Sridhar Kamath, MBBS Gregory Y.H. Lip, MD City Hospital Birmingham, England, UK References 1. Ernofsson M, Strekerud F, Toss H, et al. Klein W, Buchwald A, Hillis SE, et al. Cohen M, Demers C, Gurfinkel EP, et al.