Anticoagulation with low-molecular-weight heparin in patients with heart diseases

Low-molecular-weight heparins (LMWH) were investigated in different cardiac diseases requiring anticoagulation. In case of short term usage advantages over intravenous unfractionated heparin (UFH) are of relevance, such as simple subcutaneous application, possibility for outpatient treatment and predictable effect on anticoagulation enabling abstention of laboratory monitoring in most cases. Thromboprophylaxis in acute medically ill patients and therapy of non-ST-elevation acute coronary syndromes (NSTE-ACS) are important indications, in which significant advantages for special LMWH as compared to Placebo or UFH were shown. A significant effect versus Placebo was demonstrated for the LMWH Dalteparin in prolonged anticoagulation until revascularisation procedure in NSTE-ACS. Promising results from trials were also published concerning use of LMWH Dalteparin and Enoxaparin in TEE-guided cardioversion. Findings from cohort trials are available for temporary or long term switch from oral anticoagulation to LMWH. Due to limited data, determination of individual benefit-to-risk ratio is of special importance to select suitable anticoagulation regimen in this case. Further investigations as a basis of general recommendations on standard dosing regimen are outstanding for use of each LMWH in percutaneous coronary interventions, as combination with Glycoprotein IIb/IIIa-inhibitors, in acute myocardial infarction and in artificial heart valves. In cardiology, most studies were performed with Dalteparin and Enoxaparin, suggesting these to be used in established cardiac indications as well as in further investigations.