New data in treatment of acute coronary syndromes.
BACKGROUND
Anticoagulants are important in the treatment of acute coronary syndromes (ACS). When given in combination with aspirin, unfractionated heparin (UHF) improves the clinical outcome in patients who have ACS without ST-segment elevation. UHF also has potential benefits when administered in conjunction with fibrinolytic agents, especially those that are fibrin-specific. The anticoagulant effect of standard heparin is unpredictable, and excessive bleeding complications have been observed in nearly all trials.


METHODS
New anticoagulants, including direct antithrombins, low-molecular-weight heparins, and more recently, agents with a pure anti-Factor Xa effect, have been tested in patients with ACS and found to have varying degrees of clinical relevance.


RESULTS
One new synthetic pentasaccharide, Org31540/SR90107A, an antithrombin III-binding selective inhibitor of Factor Xa, has been studied in more than 300 patients with acute myocardial infarction with ST-segment elevation (PENTALYSE trial). In an ongoing trial (PENTUA), Org31540/SR90107A is being compared with enoxaparin in patients with ACS, with and without ST-segment elevation.


CONCLUSIONS
Org31540/SR90107A has shown promising results in ACS with ST-segment elevation. Efficacy in ACS without ST-segment elevation is currently under evaluation.
Van de Werf
F
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Department of Cardiology, Gasthuisberg University Hospital, Leuven, Belgium. Fans.VandeWerf@uz.kuleuven.ac.be
D000925:Anticoagulants / Q000627:therapeutic use; D000990:Antithrombin III / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D065427:Factor Xa Inhibitors; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control*; D009844:Oligosaccharides / Q000627:therapeutic use*; D013577:Syndrome; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D006495:Heparin, Low-Molecular-Weight; D009844:Oligosaccharides; C417062:SR 90107A-ORG 31540; D014859:Warfarin; D000990:Antithrombin III; D001241:Aspirin