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Low-molecular-weight heparins in the treatment of acute coronary syndromes

A G Turpie1, E M Antman

  • 1HHSC-General Division, 237 Barton St E, Hamilton, Ontario, Canada L8L 2X2. turpiea@mcmaster.ca

Archives of Internal Medicine
|June 28, 2001
PubMed

Insights

Low-molecular-weight heparins offer advantages over unfractionated heparin for acute coronary syndromes. Enoxaparin sodium specifically reduced coronary events in non-ST segment elevation ischemia patients.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Platelet aggregation and coagulation activation are central to acute coronary syndromes (ACS).
  • Patients with ACS face high risks of mortality and myocardial infarction, necessitating antithrombotic therapy.
  • Unfractionated heparin is effective but has limitations like monitoring needs and bleeding risks.

Purpose of the Study:

  • To evaluate the role and efficacy of low-molecular-weight heparins (LMWHs) in managing acute coronary syndromes.
  • To compare the clinical benefits of LMWHs against unfractionated heparin.
  • To identify specific LMWH agents with proven efficacy in ACS patient subgroups.

Main Methods:

  • Review of clinical trials comparing LMWHs with unfractionated heparin in ACS patients.
  • Analysis of efficacy and safety data for various LMWH products.
  • Focus on outcomes in patients with non-ST segment elevation acute coronary ischemia.

Main Results:

  • Low-molecular-weight heparins provide practical and clinical advantages over unfractionated heparin, including better bioavailability and subcutaneous administration.
  • Different LMWHs possess distinct biochemical and pharmacologic properties, making direct efficacy prediction challenging.
  • Enoxaparin sodium is the only LMWH demonstrated in clinical trials to reduce coronary events in patients with non-ST segment elevation acute coronary ischemia when compared to heparin.

Conclusions:

  • LMWHs are valuable antithrombotic agents for acute coronary syndromes, offering improved administration and bioavailability.
  • Selection of a specific LMWH should rely on product-specific efficacy and safety data.
  • Enoxaparin sodium has shown a specific benefit in reducing coronary events for non-ST segment elevation acute coronary ischemia.

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