Is the use of unfractionated heparin in acute coronary syndrome outmoded?

被引：0
作者：
Chiquette E. [1 ]
Chilton R. [1 ]
机构：
[1] Department of Medicine, Audie Murphy VA Hospital, Univ. of Texas Health Science Center, San Atonio, TX 78282
来源：
Current Atherosclerosis Reports | 2004年 / 6卷 / 2期
关键词：
Percutaneous Coronary Intervention; Acute Coronary Syndrome; Enoxaparin; Abciximab; Unfractionated Heparin;
D O I：
10.1007/s11883-004-0096-4
中图分类号：
学科分类号：
摘要：
Because of the key role of thrombin in the pathogenesis of acute coronary syndrome (ACS), the appropriate selection of antithrombotic therapy is important. Unfractionated herapin (UFH) has been the agent of choice for decades. Unfortunately, UFH has a number of limitations related to its pharmacokinetic and pharmacodynamic properties. Low molecular weight herapins (LMWHs) are attractive alternatives to UFH for several reasons, including predictable anticoagulation and ease of administration. Two LMWhs (dalteparin and enoxaparin) have been approved as alternatives to UFH in patients presenting with unstable angina and non-ST-segment elevation myocardial infarction. Randomized, controlled trials, in addition to open-label series, indicate that LMWH can safety be the agent of choice with or without glycoprotein llb/llla in the medical and upstream management of patients with ACS. Although the data are not definitive, several trials suggest that given intravenously, enoxaparin is safe as the sole antithrombotic agent in the catheterization laboratory. Copyright © 2004 by Current Science Inc.
引用
收藏
页码：94 / 100
页数：6
相关论文
共 34 条
  • [1] Hirsh J., Herapin, N. Engl. J. Med., 324, pp. 1565-1574, (1991)
  • [2] Klien W., Buchwald A., Hillis S.E., Et al., Comparison of low molecular weight herapin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Fragmin in Unstable Coronary Artery Disease Study (FRIC), Circulation, 96, pp. 61-68, (1997)
  • [3] Cohen M., Demers C., Gurfinkel E.P., Et al., A comparison of low molecular weight heparin with unfractionated heparin for unstable coronary artery disease, N. Engl. J. Med., 337, pp. 447-452, (1997)
  • [4] Antmann E.M., Cohen M., Radley D.R., Et al., Assessment of the treatment effect of enoxaparin for unstable angina/non-Q wave myocardial infarction: TIMI-11B-ESSENCE meta-analysis, Circulation, 100, pp. 1602-1608, (1999)
  • [5] Antman E., Cohen M., Radley D., Et al., Assessment of the treatment effect of enoxaparin for unstable angina/non-Q-wave myocardial infarction. TIMI 11B-ESSENCE meta-analysis, Circulation, 100, pp. 1602-1608, (1999)
  • [6] Simmoons M., PENTUA results, (2001)
  • [7] Michalis L.K., Katsouras C.S., Papamichael N., Et al., Enoxaparin versus tinzaparin in non-ST-segment elevation acute coronary syndromes: The EVET trial, Am. Heart J., 146, pp. 304-310, (2003)
  • [8] Cohen M., Theroux P., Weber S., Et al., Combination therapy with tirofiban and enoxaparin in acute coronary syndromes, Int. J. Cardiol., 71, pp. 273-281, (1999)
  • [9] Goodman S.G., Randomized evaluation of the safety and efficacy of enoxaparin versus unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes receiving the glycoprotein IIb/IIIa inhibitor eptifibatide, Circulation, 107, pp. 238-244, (2003)
  • [10] Ferguson J.J., Antman E., Bates E., Et al., The Use of Enoxaparin and IIb/IIIa Antagonists in Acute coronary Syndromes, including PCI, (2000)
1234