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Lovenox vs. aspirin: Search engine PICO study

Lovenox vs. aspirin: Search engine PICO study

Heart disease claims the lives of many Americans. However, despite the common nature of the condition, the right cocktail of pharmacological treatments for patients continues to be fine-tuned. Aspirin therapy has long been the most commonly recommended drug treatment for coronary disease. For some patients Lovenox has also been used in conjunction or substitution with traditional aspirin therapy. Lovenox is an anticoagulant therapy that can help reduce the risk of developing DVT, or deep vein thrombosis.

Patient/population: Patients with heart disease

Intervention: Drug treatment (as opposed to lifestyle alterations)

Comparison: Is aspirin or Lovenox a superior method of treating patients with heart disease?

Outcome: Combination therapy is indicated but the benefits of aspirin therapy seem to be confirmed in almost all available studies (Ramanath & Eagle 2007)

Timeframe: Literature review -- not specified

Search process

At first, I plugged the words 'aspirin' and 'Lovenox' into the search engine of the National Center for Biotechnology Information of the U.S. National Library of Medicine, but unsurprisingly got many irrelevant studies focusing on aspirin. Writing 'aspirin' and 'Lovenox' and 'heart disease' also brought forth far too many results, and far too many useless responses. Finally, after writing aspirin, Lovenox, and coronary disease, I retrieved a study in the American Journal of Cardiovascular Drugs 2007; 7(2):95-116 pertinent to my question entitled: "Evidence-based medical therapy of patients with acute coronary syndromes" by V.S. Ramanath and K.A. Eagle. The study reviewed current pharmacologic therapies for coronary disease, including antiplatelet therapies such as aspirin and anticoagulants such as unfractionated and low molecular weight heparin. The study found that combination therapies of antiplatelet drugs, beta-adrenoceptor antagonists, ACE inhibitors to treat high blood pressure, and lipid-lowering agents such as statins showed the clearest benefit in ameliorating study participant's heart disease.

The study design was qualitative in the sense that it was a literature review, but it did include quantitative studies in its examination of different treatments for the condition. "With new clinical trials being conducted, our knowledge of latest therapies for ACS continually evolves. In this article, we review currently available medical therapies and provide evidence-based rationale for current pharmacologic therapies" (Ramanath & Eagle 2007).

One of the problems in using a literature review format is that by grouping studies together, it is difficult to come to a clear conclusion regarding the superiority of one treatment over another, given that all of the studies have extraneous or additional factors that do not necessarily apply to the core clinical question. A number of the studies reviewed by Ramanath and Eagle involved diabetes patients, which present unique clinical challenges for the practitioner in prescribing effective and safe drug treatments. Some of the other studies also involved the use of statin drugs in combination with aspirin and Lovenox (heparin) as a method of preventative care, but the degree to which this impacted the results was also unremarked-upon. Finally, the question of non-drug treatment and recommendations for study participants to improve their health with diet and exercise was not noted in any of the studies: whether lifestyle alterations were controlled in the data is unclear, and the degree to which one group of patients may have altered their lifestyles through diet and exercise in conjunction with drug treatments was not noted. In terms of the comparison between aspirin and heparin: "among the antiplatelet therapies, aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitors demonstrate significant efficacy in reducing morbidity and mortality. Among the anticoagulants, unfractionated heparin and low molecular weight heparin, particularly enoxaparin sodium, remain the hallmarks of therapy against which newer anticoagulants are often compared. Bivalirudin has recently showed significant efficacy in decreasing cardiovascular events and mortality, but with potentially less risk of bleeding than heparin." Thus aspirin, beta-blockers, blood pressure lowering medications, and cholesterol lowering medications in combination were deemed to be the most vital elements of treating heart disease, although heparin did show some benefits as well and was not contraindicated.