Coronary heart disease, unstable angina, PTCA: new indications for low molecular weight heparins?
Unstable angina in patients with coronary heart disease carries a high risk of myocardial infarction (MI) and death. Partial thrombotic occlusions of coronary arteries are a major causal factor in the development of unstable angina and consecutive thrombotic occlusions may lead to MI. Treatment with unfractionated heparin (UFH) has been shown to significantly reduce the frequency of anginal attacks, but not to affect the frequency of MI, PTCA and death within one month. Prolonged treatment with low molecular weight heparins (LMWHs) may improve the outcome in patients with unstable angina. New clinical studies in this area seem promising. In the prevention of early reocclusions after PTCA LMWHs may be more effective than UFH. Late restenosis after PTCA within 6 months occurs in 25-35% of patients. To date, no effective prophylaxis exists. In a recent trial, short-term treatment with a LMWH had no preventive effect on late restenoses. Ongoing trials with long-term treatment may lead to better results. In the near future long-term treatment, up to six months, with a LMWH alone or in combination with a platelet function inhibitor, possibly with reduced doses of both drugs, may reduce the frequency of restenosis.
Breddin
H K
HK
International Institute of Thrombosis and Vascular Diseases, Frankfurt am Main, Germany.
D000789:Angina, Unstable / Q000188:drug therapy* / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin