This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (25)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Thrombolysis  • Review  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

Alexander G. G. Turpie, MD; Elliott M. Antman, MD

Arch Intern Med. 2001;161:1484-1490.

Platelet aggregation and activation of coagulation are key events in the development of acute coronary syndromes. Patients with an acute coronary syndrome are at high risk of death or myocardial infarction, and hence there is a strong rationale for the use of antithrombotic agents. Heparin has been shown to reduce the risk of death or myocardial infarction in aspirin-treated patients with acute coronary syndromes, but it has a number of limitations, including the need for regular monitoring and the risk of hemorrhage and thrombocytopenia. Low-molecular-weight heparins offer a number of practical and clinical advantages over unfractionated heparin, such as higher bioavailability and administration by subcutaneous injection. Several low-molecular-weight heparins are available that differ in their biochemical and pharmacologic properties, and it is not possible to predict their clinical efficacy from their pharmacologic profile. The decision regarding the use of a specific low-molecular-weight heparin should be based on the efficacy and safety data available for each product. In clinical trials comparing low-molecular-weight heparin with heparin, only enoxaparin sodium has been shown to reduce the risk of coronary events in patients with non–ST segment elevation acute coronary ischemia.

From the Department of Medicine, McMaster University, Hamilton, Ontario (Dr Turpie), and Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Mass (Dr Antman).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Low-Molecular-Weight-Heparin before Cardiac Surgery: To Give or Not To Give?
Raja
Asian Cardiovasc. Thorac. Ann. 2004;12:388-388.
FULL TEXT  

Single-Arm Study of Bridging Therapy With Low-Molecular-Weight Heparin for Patients at Risk of Arterial Embolism Who Require Temporary Interruption of Warfarin
Kovacs et al.
Circulation 2004;110:1658-1663.
ABSTRACT | FULL TEXT  

Preoperative use of enoxaparin is not a risk factor for postoperative bleeding after coronary artery bypass surgery
Medalion et al.
J. Thorac. Cardiovasc. Surg. 2003;126:1875-1879.
ABSTRACT | FULL TEXT  

Preoperative Use of Enoxaparin Compared With Unfractionated Heparin Increases the Incidence of Re-Exploration for Postoperative Bleeding After Open-Heart Surgery in Patients Who Present With an Acute Coronary Syndrome: Clinical Investigation and Reports
Jones et al.
Circulation 2002;106:I-19-I-22.
ABSTRACT | FULL TEXT  

New Approaches to Diagnosis and Management of Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: Controversial Data
Borja et al.
Arch Intern Med 2002;162:485-486.
FULL TEXT