[Direct and indirect antithrombins in acute coronary syndromes].
Unfractionated heparin (UFH) as well as low-molecular-weight heparins (LMWH), especially enoxaparin, are recommended by the current international guidelines for routine used in the conservative treatment of patients with acute coronary syndromes (ACS). UFH is still the recommended antithrombin as soon as percutaneous coronary interventions (PCI) are performed, although the results of different trials clearly have demonstrated the benefit of enoxaparin also in interventional cardiology. Bleeding complications along PCI procedures can be minimized by avoiding crossover from enoxaparin to UFH or vice versa and by reducing the dosage of indirect antithrombins, particularly of enoxaparin, in patients with chronic renal dysfunction and/or the elderly. Especially for those patient groups, bivalirudin offers already today an effective alternative. There is increasing expectation concerning the use of bivalirudin in patients undergoing PCI procedures but firm data exist at present only for low- and medium-risk patients with non ST-elevation ACS. Results of still ongoing trials (ACUITY, HORIZONS) will help to further confirm the role of bivalirudin in patients with high-risk acute coronary syndromes. For other direct antithrombins, e.g., fondaparinux (a pentasaccharide) or melagatran, comparably few data are available at present. Whether these agents will make their way into clinical use, future will tell.
Höchtl
Thomas
T
3. Medizinische Abteilung mit Kardiologie und Internistischer Notaufnahme, Wilhelminenspital, Wien, Austria.
Geppert
Alexander
A
Nürnberg
Michael
M
Unger
Gerhard
G
Speidl
Walter
W
Wojta
Johann
J
Huber
Kurt
K
D000208:Acute Disease; D000789:Angina, Unstable / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D038622:Internationality; D009203:Myocardial Infarction / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013577:Syndrome; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D006493:Heparin