Low-molecular-weight heparins in acute coronary syndromes.
نویسنده
چکیده
Platelet aggregation, and activation of coagulation cascade are the key events in the development of acute coronary syndromes (ACS). Patients with this syndrome are at high risk of adverse events, such as death and myocardial infarction (MI). Optimized medical treatment for the non-ST segment elevation ACSs should consist of a combined anti-thrombotic/anti-anginal regimen. Standard anti-thrombotic treatment is currently unfractionated heparin (UH) and aspirin, and in high-risk patients glycoprotein IIb/IIIa inhibitors. UH has been shown to reduce the risk of death or myocardial infarction in aspirin-treated patients with ACSs, but it has a number of limitations, such as need for regular monitoring and the risk of hemorrhage and thrombocytopenia. Compared to UH, the low molecular weight heparins (LMWH) possess several important theoretical advantages for the treatment of patients with ACSs, including less non-specific binding, resistance to inactivation by platelet factor-4, more reliable anticoagulation effects, and greater factor anti-Xa activity. Recently published trials strongly support the use of LMWHs in the treatment of ACSs. These agents provide an alternative to UH that is at least as effective. The available evidence favours the use of these agents in acute cardiac care. This article explores the recent clinical data on the use of LMWHs in acute cardiac care, and looks critically at the differences between traditional therapies. Recommendations regarding the use of anti-thrombotic agents in patients with ACSs are also discussed.
منابع مشابه
Low-molecular-weight heparins in the management of acute coronary syndromes.
Acute coronary syndromes (unstable angina and non-Q-wave myocardial infarction) are caused by the rupture of an atherosclerotic plaque, platelet activation, and fibrin deposition resulting in thrombosis. Aspirin and unfractionated heparin have traditionally been the treatments of choice for patients with acute coronary syndromes. Low-molecular-weight heparins offer potential advantages over unf...
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متن کاملRole of low-molecular-weight heparin in the management of acute coronary syndromes.
In the past few years, several clinical trials with low-molecular-weight heparins in acute coronary syndromes without ST-segment elevation have been published. In the acute phase of treatment, enoxaparin obtained better results than unfractionated heparin, but dalteparin and nadroparin did not. Enoxaparin also obtained better results than tinzaparin. From these results, it can be assumed that t...
متن کاملAnticoagulants in coronary artery disease.
Anticoagulant therapy for acute coronary syndromes is becoming more complex as newer agents are added to unfractionated heparin and warfarin. The anticoagulants used in current clinical practice are low molecular weight heparins, direct thrombin inhibitors, and heparinoids. Properties of and recent clinical trial data regarding these newer anticoagulants are reviewed in reference to current Ame...
متن کاملNew advances in the management of acute coronary syndromes: 4. Low-molecular-weight heparins.
متن کامل
Low-molecular-weight heparins for the treatment of acute coronary syndromes.
Low-molecular-weight heparins (LMWHs) possess several advantages over unfractionated heparin (UFH) for the treatment of acute coronary syndromes (ACSs). Already a class I indication for the treatment of unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI), LMWHs also show promise in the setting of ST elevation myocardial infarction (STEMI) and percutaneous coronary intervention (P...
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عنوان ژورنال:
- Current vascular pharmacology
دوره 1 3 شماره
صفحات -
تاریخ انتشار 1998