PMID- 11209983
OWN - NLM
STAT- MEDLINE
DCOM- 20010405
LR  - 20131121
IS  - 0785-3890 (Print)
IS  - 0785-3890 (Linking)
VI  - 32 Suppl 1
DP  - 2000 Dec
TI  - Acute and prolonged treatment with low-molecular-weight heparin therapy in 
      patients with unstable coronary artery disease.
PG  - 53-9
AB  - Unstable angina and non-ST-segment elevation myocardial infarction (MI) are known 
      as unstable coronary artery disease (UCAD). They are syndromes that share a 
      common pathobiology and represent a frequently encountered and potentially 
      life-threatening medical condition. Acute-phase treatment with aspirin is 
      associated with a significant reduction in death and non-fatal MI in patients 
      with UCAD. This benefit is enhanced by the addition of unfractionated heparin 
      (UFH) to the treatment strategy; however, UFH requires careful monitoring and 
      titration. In contrast, low-molecular-weight heparins (LMWHs), produced by 
      chemical or enzymatic depolymerization of UFH, yield a predictable and consistent 
      pharmacokinetic profile and anticoagulant response making them an attractive 
      alternative treatment to UFH in patients with UCAD. In several studies, 
      acute-phase treatment with LMWH has been shown to be at least as effective and 
      safe as UFH. The optimal duration of treatment with LMWH is an important question 
      that has been influenced by the observation that reactivation of coagulation 
      occurs following the early and abrupt discontinuation of heparin treatment. In 
      early trials, such as FRISC (Fragmin during instability in coronary artery 
      disease) and FRIC (Fragmin in unstable coronary artery disease), the results of 
      extended treatment were inconclusive; however, the trial populations included 
      patients of relatively low risk and used a once-daily dosing regimen. In the TIMI 
      11B (Thrombolysis in myocardial infarction) extended treatment beyond the few 
      days of acute treatment with enoxaparin did not add to the beneficial LMWH 
      effect, but in this study 40% of the high-risk patients did not continue on 
      extended treatment. The findings derived from the FRISC II trial, which used a 
      twice-daily dose of dalteparin sodium, suggest a benefit for up to 45 days with 
      extended treatment in high-risk UCAD patients. Although an early invasive 
      treatment strategy is particularly beneficial, patients in whom early 
      revascularization is not possible should be considered for extended treatment 
      with dalteparin sodium awaiting percutaneous coronary intervention.
FAU - Husted, S
AU  - Husted S
AD  - Department of Cardiology and Medicine A, Aarhus Amtssygehus, Aarhus University 
      Hospital, Denmark. Steen.Husted@aas.auh.dk
FAU - Kher, A
AU  - Kher A
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Review
PL  - England
TA  - Ann Med
JT  - Annals of medicine
JID - 8906388
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Angina, Unstable/*drug therapy
MH  - Dalteparin/therapeutic use
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Syndrome
RF  - 21
EDAT- 2001/02/24 12:00
MHDA- 2001/04/06 10:01
CRDT- 2001/02/24 12:00
PHST- 2001/02/24 12:00 [pubmed]
PHST- 2001/04/06 10:01 [medline]
PHST- 2001/02/24 12:00 [entrez]
PST - ppublish
SO  - Ann Med. 2000 Dec;32 Suppl 1:53-9.