Additional clinical benefit of enoxaparin in COPD patients receiving salmeterol and fluticasone propionate in combination

It is now well recognised that heparin possesses numerous anti-inflammatory properties in addition to its anticoagulant properties. Thus, the aim of this study was to investigate the effects of the low molecular weight heparin, enoxaparin (ENX), as an add-on therapy for a period of 12 weeks, to inhaled salmeterol/fluticasone propionate (SLM/FP) combination in patients with stable chronic obstructive pulmonary disease (COPD). Forty-six patients were randomised to receive 12 weeks of treatment in one of two treatment groups: (1) fixed combination of SLM 50μg and FP 500μg Diskus, one inhalation twice daily; or (2) as group 1 plus 20mg ENX administered subcutaneously once daily for 12 weeks. Patients attended the clinic before and after 4, 8 and 12 weeks of treatment for evaluations of lung function, blood gas tensions, dyspnoea and supplemental salbutamol use. Thirty-six patients completed the 12-week treatment period, 20 from group 1 and 16 from group 2. A significant increase in forced expiratory volume in 1s (FEV1) over baseline was observed after 12 weeks of treatment in group 1 (0.145L, 95% CI: 0.994–1.406, p<0.01), whilst significant increases in FEV1 over baseline were observed in group 2 after 4, 8 and 12 weeks of treatment with a maximum increase at 12 weeks of 0.244L (95% CI: 1.175–1.596, p<0.01). Both treatment groups experienced similar improvements in blood gas tensions, dyspnoea and supplemental salbutamol use. Our results suggest that addition of ENX to conventional therapy of COPD may provide additional clinical benefit and must be further investigated as a treatment for COPD.