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Peter J. Zed, PharmD; James E. Tisdale, PharmD; Steven Borzak, MD

Arch Intern Med. 1999;159:1849-1857.

Acute coronary syndromes (unstable angina and non–Q-wave myocardial infarction) are caused by the rupture of an atherosclerotic plaque, platelet activation, and fibrin deposition resulting in thrombosis. Aspirin and unfractionated heparin have traditionally been the treatments of choice for patients with acute coronary syndromes. Low-molecular-weight heparins offer potential advantages over unfractionated heparin, having proven equally effective for the treatment and prevention of many thromboembolic processes. Recently, a number of randomized controlled trials have been conducted to evaluate the role of low-molecular-weight heparins in the management of patients with unstable angina or non–Q-wave myocardial infarction. The purpose of this article is to review and evaluate the available literature on the use of low-molecular-weight heparins in the management of acute coronary syndromes to establish their role in therapy.

From CSU Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Center, and the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver (Dr Zed); and the Department of Pharmacy Practice, College of Pharmacy and Allied Health Professions, Wayne State University and Department of Pharmacy Services (Dr Tisdale), and the Cardiac Intensive Care Unit, Division of Cardiovascular Medicine (Dr Borzak), Henry Ford Hospital, Detroit, Mich.

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