The role of low-molecular-weight heparin in the management of acute coronary syndromes.
Optimized medical treatment for the non-ST segment elevation acute coronary syndromes (NSTE ACS) should consist of a combined antithrombotic/anti-anginal regimen. Standard antithrombotic treatment is currently unfractionated heparin and aspirin, and in high-risk patients glycoprotein IIb/IIIa inhibitors. However, low-molecular-weight heparins (LMWHs) have practical and clinical advantages over UFH and can be considered an effective alternative in the medical treatment of ACS and in patients proceeding to surgical interventions. Benefits include a more predictable and stable therapeutic response, no need for coagulation monitoring and a reduced incidence heparin-induced thrombocytopenia. In this context, the LMWH enoxaparin has demonstrated sustained clinical and economic benefits compared with UFH, with no increase in major bleeding complications. In addition, recently published studies indicate that LMWHs can improve reperfusion of the arteries and reduce reocclusion when used as adjunctive anticoagulant therapy in patients with ST segment elevation (STE) ACS undergoing thrombolysis with fibrin-specific agents or streptokinase.
Cohen
M
M
Division of Cardiology, MCP-Hahnemann School of Medicine, Philadelphia, Pennsylvania 19102-1192, USA. marc.cohen@tenethealth.com
D000925:Anticoagulants / Q000627:therapeutic use*; D006328:Cardiac Catheterization; D003131:Combined Modality Therapy; D017985:Dalteparin / Q000627:therapeutic use; D004311:Double-Blind Method; D017984:Enoxaparin / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D017762:Nadroparin / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D017762:Nadroparin; D017985:Dalteparin