Indonesia: New research has shown that enoxaparin appears more effective than Heparin in reducing mortality among patients with Acute Coronary Syndrome. However, Hypertension was identified as a significant risk factor for bleeding, indicating the need for careful patient selection and confirmation through larger studies.The findings were reported in a study published in Current Cardiology Reviews by Rini Noviyani from the Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Udayana University, Bali, Indonesia, and colleagues. The research compared the therapeutic benefits and safety profiles of Enoxaparin and Heparin in patients diagnosed with Acute Coronary Syndrome (ACS).Acute coronary syndrome is a major contributor to cardiovascular morbidity and mortality worldwide. Anticoagulant medications play an important role in its management by preventing clot formation and reducing the risk of further cardiac events. Although both enoxaparin and heparin are commonly used in clinical settings, evidence comparing their outcomes in real-world populations remains limited.To explore this, the researchers conducted a retrospective cross-sectional observational study using medical records of patients treated for ACS at Prof. Dr. I.G.N.G. Ngoerah Hospital and RSUD Tabanan in Bali, Indonesia. The records reviewed covered the period from January 2021 to December 2023. Because the study relied on previously recorded data, no randomization or blinding procedures were performed.A total of 73 patients with acute coronary syndrome were included in the analysis. Among them, 60 patients received enoxaparin while 13 were treated with heparin. The main outcomes assessed were recurrence of myocardial infarction and mortality, while bleeding events were evaluated as a secondary outcome. The researchers used logistic regression analysis to adjust for potential confounding factors, including age, sex, hypertension, diabetes, chronic kidney disease, and ACS subtype. The analysis revealed the following:Recurrence of myocardial infarction occurred in 6.7% of patients treated with Enoxaparin, while no cases were reported among those receiving Heparin.Mortality rates differed significantly between the two treatment groups, with 3.3% mortality in the enoxaparin group compared with 30.8% in the heparin group.Bleeding events were relatively uncommon in both groups, occurring in 5% of patients receiving enoxaparin and 7.7% of those treated with heparin.Overall bleeding risk did not differ significantly between the two anticoagulant therapies.Hypertension was identified as a significant factor associated with an increased risk of bleeding during treatment.Other variables, including age, sex, diabetes, chronic kidney disease, and subtype of Acute Coronary Syndrome, were not significantly associated with bleeding risk.The researchers concluded that enoxaparin may offer a mortality advantage over heparin in patients with acute coronary syndrome while maintaining a similar safety profile. They also highlighted the importance of careful management of hypertensive patients receiving anticoagulant therapy and recommended larger prospective studies to confirm these findings.Reference: 10.2174/011573403X414877251124225616