Which heparin and how much?
Acute coronary syndromes (ACS) are among the most common presentations to emergency departments in North America. An important therapeutic decision facing the clinician is whether antithrombotic therapy is justified and which type confers the lowest risk:benefit ratio. Using low molecular weight heparin (LMWH) has resulted in improved cardiovascular outcomes over unfractionated heparin in the noninvasively treated; however, its use as the antithrombotic agent in the invasive management of ACS has not always been superior. There have also been concerns about bleeding risk with LMWH, especially in the elderly and those with impaired renal function. The longer half-life of LMWH and the complexity of reversing its effect, in the context of multiple antiplatelet and fibrinolytic drugs, have also spurred debate. Finally, there is concern over unwanted thrombotic events with these agents in the cardiac catheterization laboratory.
Ruchin
Peter E
PE
Cardiac Catheterization Laboratory, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7.
Labinaz
Marino
M
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D000077425:Fondaparinux; D006493:Heparin / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011134:Polysaccharides / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux