Review: Low-molecular-weight herapin is effective and safe in the acute coronary syndromes: COMMENTARY

Hillegass, William B.; Brott, Brigitta C.
November 2003
ACP Journal Club;Nov/Dec2003, Vol. 139 Issue 3, p58
Academic Journal
Researcher G.C. Wong and colleagues have provided a systematic review of trials comparing low molecular weight heparin (LMWH) and un-fractionated heparin (UFH) in patients with acute coronary syndrome (ACS). In patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), enoxaparin reduced ischemic events more than UFH. Major bleeding was not increased even among those patients proceeding to percutaneous coronary intervention (PCI). Achieving this in practice requires appropriate weight-based dosing, meticulous attention to the timing of PCI, sheath removal relative to the last dose of LMWH, and optimal use of closure devices. Thus, among patients with UA/NSTEMI who have no contraindication to anti-thrombin therapy, LMWH, in particular enoxaparin, is superior to UFH for reducing ischemic events without increasing bleeding. In patients with STEMI receiving thrombolytic therapy, the use of adjunctive LMWH, compared with UFH, lowers the risk for recurrent ischemic events without increased risk for major bleeding in patients less than 75 years of age.


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