[Low molecular weight heparins in acute coronary syndrome].
BACKGROUND
Low molecular weight heparins (LMWH) have gained an increased role in the treatment of acute coronary syndrome within the last years. Compared to unfractionated heparins LMWH are user-friendly (high bioavailability after subcutaneous application, no needed routine control of plasma efficacy).


RESULTS
International trials have demonstrated a comparable (dalteparin, nadroparin) or even higher (enoxaparin) efficacy of LMWH compared to unfractionated heparin in the treatment of patients with unstable angina or non-Q-wave infarction. The use of LMWH has thereby been accompanied by a low rate of side effects. Enoxaparin appears to have the highest efficacy compared with other LMWH in the acute phase of disease, but confirming "head-to head" studies with different LMWH are lacking. A significant higher efficacy of a prolonged treatment with LMWH compared to placebo has been shown in one study (FRISC-2) in unstable patients who were not treated by coronary intervention in the early phase of disease. This lasted for about 60 days but was associated with a higher risk of bleeding.


CONCLUSIONS
Currently, prospective clinical trials investigate the efficacy of combined use of LMWH with thrombolytics, GPIIb/IIIa blockers and the optimal dosage of LMWH during coronary interventions.
Huber
K
K
Universitätsklinik für Innere Medizin II, Abteilung für Kardiologie, Universität Wien. kurt.huber@univie.ac.at
Niessner
A
A
Niessner
H
H
D000208:Acute Disease; D000789:Angina, Unstable / Q000188:drug therapy*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D017985:Dalteparin / Q000008:administration & dosage / Q000627:therapeutic use; D017984:Enoxaparin / Q000008:administration & dosage / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D017762:Nadroparin / Q000008:administration & dosage / Q000627:therapeutic use; D010919:Placebos; D012307:Risk Factors; D013577:Syndrome; D009626:Terminology as Topic; D013997:Time Factors
D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D017762:Nadroparin; D010919:Placebos; D017985:Dalteparin