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Low-molecular-weight heparins for acute coronary syndromes
1Philadelphia College of Pharmacy and Science, PA 19104, USA.
Insights
Low-molecular-weight heparins (LMWHs) show promise in treating acute coronary syndromes, potentially being more effective than unfractionated heparin (UFH). However, more research is needed to confirm bleeding risks and cost-effectiveness before routine use can be recommended.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Acute coronary syndromes (ACS), including unstable angina and myocardial infarction (MI), represent a significant cause of morbidity and mortality.
- Standard unfractionated heparin (UFH) has been the cornerstone of anticoagulant therapy in ACS.
- Low-molecular-weight heparins (LMWHs) offer potential advantages in administration and monitoring.
Purpose of the Study:
- To review the existing literature on the efficacy and safety of LMWHs in managing unstable angina and acute MI.
- To compare the outcomes of LMWH treatment with standard UFH therapy.
Main Methods:
- A comprehensive literature search of MEDLINE was conducted from January 1986 to August 1997.
- Pertinent articles and abstracts from recent clinical trials were selected for review.
- References from identified articles were also reviewed to ensure comprehensive coverage.
Main Results:
- Published studies suggest LMWHs are as effective or more effective than UFH in preventing death, MI, and recurrent ischemia in ACS patients.
- LMWHs offer convenient dosing (once or twice daily) without requiring regular activated partial thromboplastin time monitoring.
- The comparative incidence of bleeding with LMWHs versus UFH remains controversial, with some studies reporting lower rates and one reporting higher rates.
Conclusions:
- LMWHs demonstrate comparable or superior efficacy to UFH in preventing adverse events in acute coronary syndromes.
- Further research is essential to clarify the comparative bleeding risks between LMWHs and UFH.
- Lack of peer-reviewed trial results and pharmaco-economic data currently preclude recommending routine LMWH use for unstable angina and acute MI.
Objective:
To review published literature regarding the use of low-molecular-weight heparins (LMWHs) for the acute coronary syndromes of unstable angina and acute myocardial infarction (MI).
Methods:
A MEDLINE search (January 1986-August 1997) was performed to identify all pertinent articles. Selected references from these articles and abstracts of recent clinical trials were also included.
Discussion:
LMWHs have several distinct advantages over standard unfractionated heparin (UFH). These advantages include convenient once- or twice-daily standardized administration without the need for activated partial thromboplastin time monitoring. While the use of LMWHs as prophylaxis and treatment of venous thromboembolism is fairly well-established, the use of LMWHs for treating acute myocardial ischemia is evolving. Published studies and abstracts have shown LMWHs to be as effective as or more effective than UFH in preventing death, myocardial infarction, and recurrent ischemia in patients with unstable angina or acute MI. The comparative incidence of bleeding between LMWHs and UFH is controversial, with some studies reporting lower or similar rates of bleeding with LMWHs, while one study demonstrated a higher bleeding rate than with UFH. The cost-effectiveness of using LMWHs over UFH for acute coronary syndromes also remains to be established.
Conclusions:
LMWHs appear to be as effective as, and potentially more effective than, UFH in preventing complications of acute coronary syndromes. However, further studies are needed to better define the comparative bleeding risks of LMWHs and UFH. This, plus the lack of published peer-reviewed trial results and pharmaco-economic analyses, preclude the recommendation of routinely using LMWHs for treating unstable angina and acute MI at this time.