New-generation anticoagulants: the low molecular weight heparins.
Heparin has been the mainstay of acute anticoagulation therapy for decades. Within the past 20 years, several different heparin fractions-collectively known as low molecular weight heparins (LMWHs)-have been evaluated in various medical and surgical settings in which anticoagulation is routinely warranted. The LMWHs are efficacious, safe, cost-effective, and easier to administer and monitor than standard, unfractionated heparin. As LMWH use becomes more widespread, emergency physicians will use these new agents instead of unfractionated heparin for unstable angina, non-Q-wave myocardial infarction, or thromboembolic disease. This review focuses on the pharmacologic properties of unfractionated heparin and LMWH, associated complications, and the use of these agents in acute ischemic coronary syndromes, thromboembolic disease, and other selected clinical situations.
Hovanessian
H C
HC
Department of Emergency Medicine, University of California-San Francisco, USA. hoori@gte.net
D000789:Angina, Unstable / Q000188:drug therapy; D000925:Anticoagulants / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000188:drug therapy; D020246:Venous Thrombosis / Q000188:drug therapy
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight