Low molecular weight heparins combined with platelet glycoprotein IIb/IIIa inhibitors in the management of acute coronary syndromes.
Clinical trials of several platelet glycoprotein (GP) IIb/IIIa receptor inhibitors have demonstrated an unequivocal benefit of this potent antithrombotic therapy in high-risk patients with acute coronary syndromes (ACS) as well as in those undergoing percutaneous coronary intervention. In all of these major trials, however, GP IIb/IIIa inhibitors were used in combination with unfractionated (UF) heparin. Low molecular weight heparins (LMWH) have several advantages over UF heparin therapy, making them attractive alternatives for use in combination with GP IIb/IIIa inhibitors. In the INTegrelin and Enoxaparin Randomized assessment of Acute Coronary syndrome Treatment (INTERACT) study, combination therapy using the GP IIb/IIIa inhibitor eptifibatide (Integrilin) and the LMWH enoxaparin (Lovenox) in patients with high-risk non-ST-segment elevation ACS, resulted in improved outcomes compared to the currently recommended therapy of UF heparin, with better safety results. It is anticipated that the LMWHs may soon replace the traditional UF heparin for combination therapy with GP IIb/IIIa inhibitors in the medical stabilisation of patients with ACS. Results of other ongoing studies of LMWH combinations with other GP IIb/IIIa inhibitors and in the setting of percutaneous coronary intervention are awaited.
Salam
Amar M
AM
Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. amaramin@yahoo.com
D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D019039:Platelet Glycoprotein GPIIb-IIIa Complex