A randomized trial to compare the efficacy, safety, cost and platelet aggregation effects of enoxaparin and unfractionated heparin (the ESCAPEU trial)

Objective: To compare the efficacy, safety, cost and effects on platelet ag gregation of unfractionated heparin and low-molecular weight heparin in uns table angina patients. Patients and methods: Ninety-three patients with uns table angina were randomized to receive either unfractionated heparin (UFH) or enoxaparin in an open design clinical trial with blinded end point eval uation. The effects of the heparins on platelet aggregation were also compa red. Results: The composite end point of myocardial infarction, cardiac dea th, recurrent angina and need for intervention was observed in 62% of patie nts treated with UFH and in 37% of patients treated with enoxaparin (RR 1.7 , 95% CI 0.75 to 3.71, p = 0.04). There was no difference in the frequency or severity of adverse events, A cost-effectiveness analysis showed both th e heparins to be similar. Platelet aggregation was inhibited to a greater e xtent by UFH when compared to enoxaparin. Conclusions: Enoxaparin appears t o be superior in efficacy to UFH and similar to UFH in safety. No differenc e in costs was detected in this study. The greater inhibition of platelet a ggregation observed in the case of UFH compared to enoxaparin indicates tha t there may be more bleeding complications with UFH.