Heparin vs. Enoxaparin for Unstable Coronary Artery Disease

Abstract This chapter appraises the ESSENCE trial, comparing enoxaparin and unfractionated heparin (UFH) for treating unstable angina (UA) and non–ST segment myocardial infarction (NSTEMI). The trial showed that enoxaparin significantly reduce the composite risk of death, myocardial infarction, or recurrent angina at 14 and 30 days compared to UFH. Enoxaparin lowers the need for coronary revascularization and is more effective in patients over 65 and those with prior coronary procedures or specific electrocardiogram changes. However, the enoxaparin group showed a higher incidence of minor hemorrhagic complications. Finally, the chapter concludes that enoxaparin, supported by subsequent trials and clinical guidelines, should be the preferred treatment for most patients with UA and NSTEMI.