title: Anticoagulants in ischemia-guided management of non-ST-elevation acute coronary syndromes.
abstract: BACKGROUND
  The most recent joint guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) on the management of non-ST-elevation acute coronary syndromes (NSTE-ACS) are a result of a substantial and considered undertaking, and those involved deserve much recognition for their efforts. However, the handling of anticoagulants seems somewhat inadequate, and this is a highly-relevant matter when managing NSTE-ACS.
  
  
  OBJECTIVE
  Among areas of potential uncertainty, emergency medicine professionals might still be left wondering about the particulars of anticoagulant therapy when pursuing ischemia-guided management of NSTE-ACS (that is, managing NSTE-ACS without an intent for early invasive measures, such as coronary angiography and revascularization). This review seeks to provide insight into this question.
  
  
  CONCLUSIONS
  Relevant clinical trials are appraised and translated into clinical context for emergency medicine professionals, including the implications of noteworthy advancements in the management of NSTE-ACS.
  
  
  CONCLUSIONS
  Although current guidelines from the AHA and ACC suggest enoxaparin has better evidence than other anticoagulants in the setting of NSTE-ACS management, careful review of the evidence shows this is not actually clearly supported by the available evidence in the era of contemporary management. Unless and until better contemporary data emerge, emergency medicine professionals must carefully weigh the available evidence, its limitations, and the possible clinical implications of the various anticoagulant options when managing NSTE-ACS.
authors.affiliation: East Carolina University, 4310N Health Sciences Building, Greenville, NC 27858-4353, United States; Vidant Medical Center, 2100 Stantonsburg Rd, Greenville, NC 27834, United States. Electronic address: mayerm@ecu.edu.
authors.forename: Martin
authors.initials: M
authors.lastname: Mayer
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000572:American Heart Association; D000789:Angina, Unstable / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000592:standards; D004638:Emergency Treatment / Q000592:standards*; D017984:Enoxaparin / Q000627:therapeutic use; D000077425:Fondaparinux; D006493:Heparin / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D011134:Polysaccharides / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D016896:Treatment Outcome; D014481:United States
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; C078918:ITF 300; D006493:Heparin; D000077425:Fondaparinux
keywords: Anticoagulant; NSTE-ACS; Non-ST-elevation acute coronary syndromes; Non-ST-elevation myocardial infarction; Unstable angina