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Dalteparin for acute coronary syndromes
1Division of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York 11201-5497, USA.
Insights
Dalteparin, a low molecular weight heparin (LMWH), shows early protective effects in acute coronary syndromes. While not beneficial long-term, it may reduce risks for patients awaiting procedures.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Acute coronary syndromes (ACS) represent a significant burden on healthcare systems.
- Low molecular weight heparins (LMWHs) offer advantages over unfractionated heparin (UFH) for ACS treatment.
- Dalteparin is an LMWH approved for unstable angina and non-Q wave myocardial infarction (NQWMI).
Purpose of the Study:
- To evaluate the efficacy of dalteparin in combination with aspirin for treating unstable angina and NQWMI.
- To assess the short-term and long-term benefits of dalteparin in patients with acute coronary syndromes.
Main Methods:
- Three large clinical trials (FRISC, FRIC, FRISC II) were conducted.
- Dalteparin was administered subcutaneously, often with aspirin.
- Outcomes included prevention of death or myocardial infarction (MI) at various time points.
Main Results:
- FRISC suggested a potential need for longer treatment durations (>6 days).
- FRIC found no significant difference between dalteparin and UFH in the acute phase or beyond.
- FRISC II showed a significant reduction in death or MI at 30 days, but not at 3 or 6 months.
Conclusions:
- Dalteparin demonstrates early protective effects in ACS patients, potentially lowering event risk.
- The benefits of dalteparin appear to be primarily in the acute phase or for patients awaiting procedures.
- Further research may be needed to optimize treatment duration and patient selection for dalteparin therapy.
Abstract:
Acute coronary syndromes account for tens of thousands of emergency room visits and cost the United States healthcare system billions of dollars each year. Dalteparin is a low molecular weight heparin (LMWH) recently approved for treatment of unstable angina and non-Q wave myocardial infarction (NQWMI). The LMWHs possess distinct advantages over unfractionated heparin (UFH). Some of these advantages include administration by subcutaneous injection with no intravenous access required; laboratory monitoring of activated partial thromboplastin time (aPTT) is not required; improved side effect profile; and more predictable and consistent anticoagulant response. In conjunction with aspirin, dalteparin was evaluated for the treatment of unstable angina and NQWMI in three large clinical trials. The FRISC study established the value of short-term dalteparin in patients with unstable coronary artery disease, but suggested that treatment with 120 IU/kg subcutaneously twice daily may be required for more than 6 days. The FRIC trial determined there was no difference between dalteparin and UFH in the acute setting for prevention of death or myocardial infarction (MI). Similar to the FRISC trial, the FRIC trial failed to demonstrate a benefit of dalteparin beyond the acute phase. The FRISC II study demonstrated a significant decrease in the composite endpoint of death or MI in the dalteparin group at 30 days, but not at 3 or 6 months. The early protective effects of dalteparin could be used to lower the risk of events in patients waiting for invasive procedures.