Low-Molecular-Weight Heparin Therapy in Acute Coronary Syndromes

Abstract

Contemporary management of patients with the acute coronary syndromes (ACS), unstable angina and non-Q-wave myocardial infarction, includes nitrates, beta blockers and/or calcium channel blockers, aspirin, anticoagulation (heparin or low-molecular-weight heparin), and antiplatelet therapy (glycoprotein IIb-IIIa inhibitor). Low-molecular-weight heparins have several pharmacological advantages over unfractionated heparin, including a more predictable anticoagulant response, subcutaneous administration, greater activity against factor Xa, and no aPTT monitoring requirement. Several large clinical trials have demonstrated that low-molecular-weight heparins, in particular enoxaparin, are superior to unfractionated heparin for the in-hospital management of ACS. In addition, the total patient care costs at 30 days appear to be lower. Existing data do not support the use of low-molecular-weight heparins after hospital discharge. Low-molecular-weight heparin efficacy has not been adequately studied in ACS patients undergoing interventions, but should be strongly considered as a replacement for unfractionated heparin in all other treatment strategies.