PMID- 11444639
OWN - NLM
STAT- MEDLINE
DCOM- 20011025
LR  - 20200225
IS  - 0160-9289 (Print)
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Linking)
VI  - 24
IP  - 7
DP  - 2001 Jul
TI  - A critical review of clinical trials for low-molecular-weight heparin therapy in 
      unstable coronary artery disease.
PG  - 492-9
AB  - Unstable angina and non-ST-segment elevation myocardial infarction (MI) are 
      collectively referred to as unstable coronary artery disease (UCAD). They are 
      conditions that share a common pathophysiology and represent frequently 
      encountered, potentially life-threatening clinical manifestations of advanced 
      atherosclerosis. Therefore, treatment of UCAD is a major focus for practicing 
      clinicians, and although pharmacologic agents have been developed that impact on 
      patient outcome, recent data suggest that a further reduction in ischemic 
      complications is possible. Acute-phase treatment with aspirin is associated with 
      a significant reduction in death and nonfatal 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 
      treatment alternative to UFH in patients with UCAD. The optimal duration of 
      treatment with LMWH is an important question influenced by the observation that 
      reactivation of coagulation occurs following the early and abrupt discontinuation 
      of heparin treatment. Early trials, such as FRISC and FRIC, demonstrated the 
      benefit of acute therapy with dalteparin sodium; however, the results of extended 
      treatment with dalteparin were inconclusive. The extended phase of these studies 
      included relatively low-risk patients, and a once-daily, relatively low-dose 
      strategy was employed. The findings derived from the FRISC II trial, which used a 
      twice-daily dose of dalteparin, suggest a benefit for at least 60 days with 
      extended treatment in high-risk patients with UCAD. 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 for up to 45 days, especially those awaiting percutaneous 
      coronary intervention. Extended treatment with dalteparin therefore provides a 
      protective "bridge" to enhance the outcome of patients with UCAD awaiting 
      revascularization.
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 - Becker, R
AU  - Becker R
FAU - Kher, A
AU  - Kher A
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Angina, Unstable/*drug therapy
MH  - Anticoagulants/*therapeutic use
MH  - Clinical Trials as Topic
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy
PMC - PMC6654785
EDAT- 2001/07/11 10:00
MHDA- 2001/10/26 10:01
PMCR- 2009/02/03
CRDT- 2001/07/11 10:00
PHST- 2001/07/11 10:00 [pubmed]
PHST- 2001/10/26 10:01 [medline]
PHST- 2001/07/11 10:00 [entrez]
PHST- 2009/02/03 00:00 [pmc-release]
AID - CLC4960240715 [pii]
AID - 10.1002/clc.4960240715 [doi]
PST - ppublish
SO  - Clin Cardiol. 2001 Jul;24(7):492-9. doi: 10.1002/clc.4960240715.