Low-molecular-weight heparins in coronary thrombosis: today and tomorrow

Data from several large-scale studies have suggested that low-molecular-weight heparin (LMWH) may be superior to standard heparin therapy in the setting of unstable coronary syndromes. Studies looking at the optimal duration of treatment have produced conflicting results; however, data from a recent large trial suggest that prolongation of treatment is associated with a significant benefit. The recommended initial treatment for patients with unstable coronary syndromes is a combination of LMWH and aspirin. Stablilized patients at moderate or high risk - such as those with ST-segment depression or increased troponin levels - should continue with this treatment until they have undergone coronary angiography and, if appropriate, an invasive procedure. In a recent small study among patients with acute myocardial infarction, the use of LMWH as an adjunct to streptokinase produced significant therapeutic benefits. Other potential uses for LMWH include a role in angioplasty.