PMID- 10841215
OWN - NLM
STAT- MEDLINE
DCOM- 20000627
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 35
IP  - 7
DP  - 2000 Jun
TI  - Low molecular weight heparin in acute coronary syndrome: evidence for superior or 
      equivalent efficacy compared with unfractionated heparin?
PG  - 1699-712
AB  - This article will review the results of recent clinical trials evaluating low 
      molecular weight heparins (LMWHs) in the management of patients with acute 
      coronary syndromes of unstable angina and non-ST segment elevation MI. Low 
      molecular weight heparins are a new class of anticoagulants that have a number of 
      advantages over unfractionated heparin (UFH) leading to their increasing use for 
      thrombotic vascular disorders. There is convincing evidence that LMWH is more 
      effective than placebo and at least as effective as UFH in reducing the hard end 
      points of death and recurrent myocardial infarction. Convincing evidence for a 
      superior efficacy is mostly limited to the least robust but most prevalent end 
      point of recurrent angina, and benefits appear to be confined predominantly to 
      high-risk patients. The benefits are sustained long-term, but there appears to be 
      no incremental benefit with prolonged treatment. The risk for major bleeding is 
      approximately equivalent to UFH, but minor hemorrhage is clearly increased, 
      especially with vascular instrumentation. The increased bleeding risk together 
      with its long half-life and absence of specific antidote warrants exercising 
      caution when using LMWH with coronary intervention. Low molecular weight heparins 
      have the potential of being cost-neutral or even cost-saving by reducing resource 
      utilization, especially in the setting of aggressive interventional practice 
      pattern. Last, the issue of whether one LMWH preparation is more effective and 
      cost-effective than others remains an open question that can be answered only by 
      direct head-to-head comparison of different LMWH preparations in randomized 
      trials. In conclusion, subcutaneous weight-adjusted LMWH is as effective and safe 
      as intravenous UFH in the management of patients with acute coronary syndromes. 
      The logistic ease of administration without the need for monitoring 
      anticoagulation appears to be the major advantage over UFH.
FAU - Kaul, S
AU  - Kaul S
AD  - Department of Medicine, Cedars-Sinai Medical Center, and UCLA School of Medicine, 
      Los Angeles, California 90048, USA. kaul@cshs.org
FAU - Shah, P K
AU  - Shah PK
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Nadroparin)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Acute Disease
MH  - Angina, Unstable/*drug therapy
MH  - Anticoagulants/*therapeutic use
MH  - Clinical Trials as Topic
MH  - Dalteparin/therapeutic use
MH  - Enoxaparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy
MH  - Nadroparin/therapeutic use
MH  - Research Design
MH  - Syndrome
RF  - 35
EDAT- 2000/06/07 09:00
MHDA- 2000/07/06 11:00
CRDT- 2000/06/07 09:00
PHST- 2000/06/07 09:00 [pubmed]
PHST- 2000/07/06 11:00 [medline]
PHST- 2000/06/07 09:00 [entrez]
AID - S0735-1097(00)00648-3 [pii]
AID - 10.1016/s0735-1097(00)00648-3 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2000 Jun;35(7):1699-712. doi: 10.1016/s0735-1097(00)00648-3.