Antithrombotics and anticoagulants in coronary syndromes and stroke

The low-molecular-weight heparins (LMWHs) have been proven superior to placebo in reducing the incidence of acute coronary ischemic syndromes. Comparative studies vs. unfractionated heparin have not demonstrated superiority in favor of the LMWH dalteparin. In the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) trial, enoxaparin was demonstrated to have a benefit over heparin. The results have contributed to a better understanding of the relative efficacy of LMWHs in acute coronary syndromes. A second trial with enoxaparin supported the conclusions of the ESSENCE trial. The antithrombotic effects of LMWHs have also been evaluated for the management of ischemic stroke with varied results. A trial assessing tinzaparin in acute ischemic stroke has completed enrollment, and its results may shed new light on the use of an LMWH for the management of stroke.