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October 27, 2004

Enoxaparin vs Unfractionated Heparin in Acute Coronary Syndrome

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(16):1952-1953. doi:10.1001/jama.292.16.1952-b

To the Editor: We would like to raise a few concerns about the article by Dr Blazing and colleagues.1 First, we are interested in the proportion of patients in the unfractionated heparin group who were able to achieve therapeutic anticoagulation with the relatively low-dose anticoagulation regimen. A recent study by Raschke et al2 showed inadequate rates of anticoagulation with unfractionated heparin in large trials that compared it with low-molecular-weight heparins. Lack of differences in efficacy or safety could be attributable to underdosing of unfractionated heparins rather than to equivalence. It would also be useful to know the dose adjustment regimen for unfractionated heparin infusion used in such high-risk unstable angina patients receiving multiple antiplatelet agents.