PMID- 15334859
OWN - NLM
STAT- MEDLINE
DCOM- 20041104
LR  - 20190917
IS  - 0277-0008 (Print)
IS  - 0277-0008 (Linking)
VI  - 24
IP  - 8 Pt 2
DP  - 2004 Aug
TI  - Unfractionated heparin in cardiology: redefining the standard of practice.
PG  - 132S-141S
AB  - Acute coronary syndromes (ACS) consist of unstable angina (UA), non-ST-segment 
      myocardial infarction (NSTEMI) and ST-segment myocardial infarction (STEMI). 
      Timely intervention with effective, predictable antithrombin therapy is 
      critically important in the early management of these conditions. Platelet 
      aggregation is also an important component of thrombus formation in arterial 
      thrombosis. Historically, unfractionated heparin (UFH) has been combined with 
      aspirin to suppress thrombin propagation and fibrin formation; however, its 
      effectiveness has been questioned in this setting. Unlike newer anticoagulant 
      alternatives, UFH paradoxically stimulates platelet aggregation, which may 
      further promote clot formation. In addition, obtaining a valid therapeutic 
      activated partial thromboplastin time (aPTT) in cardiology patients is a major 
      challenge, and dosing is complex. Due to substantial variation in reagents and 
      instruments, target aPTT ranges for UFH in ACS clinical trials cannot be 
      extrapolated to individual institutions. Further, the risk of ischemic events is 
      greater shortly after abrupt discontinuation of UFH compared with alternative 
      agents with longer half-lives and less stimulation of platelet aggregation. Key 
      UA-NSTEMI clinical trials have demonstrated that UFH is inferior to newer agents, 
      such as the low-molecular-weight heparins (LMWHs). Consistent with this evidence, 
      the most recent practice guidelines of the American College of Cardiology and the 
      American Heart Association in UA-NSTEMI identify the LMWH enoxaparin as the agent 
      of choice. In patients with STEMI receiving the fibrinolytic tenecteplase as 
      reperfusion therapy, enoxaparin has also been superior to UFH in combination. In 
      percutaneous procedures, newer indirect (enoxaparin) and direct (bivalirudin) 
      antithrombins have demonstrated safety and efficacy. There is little doubt that 
      as we move forward in optimizing adjunctive anticoagulation in the cardiology 
      setting, UFH will largely be replaced by better antithrombin agents.
FAU - Rihn, Thomas L
AU  - Rihn TL
AD  - School of Pharmacy, Duquesne University, Pittsburgh, USA. trihn@UPA-LLC.com
FAU - Diez, Jose
AU  - Diez J
CN  - Heparin Consensus Group
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 9005-49-6 (Heparin)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Angioplasty, Balloon/methods
MH  - Aspirin/therapeutic use
MH  - Drug Monitoring/standards
MH  - Drug Therapy, Combination
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heart Diseases/*drug therapy
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Partial Thromboplastin Time
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - Practice Guidelines as Topic/*standards
MH  - Randomized Controlled Trials as Topic
RF  - 39
EDAT- 2004/09/01 05:00
MHDA- 2004/11/05 09:00
CRDT- 2004/09/01 05:00
PHST- 2004/09/01 05:00 [pubmed]
PHST- 2004/11/05 09:00 [medline]
PHST- 2004/09/01 05:00 [entrez]
AID - 10.1592/phco.24.12.132s.36110 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2004 Aug;24(8 Pt 2):132S-141S. doi: 
      10.1592/phco.24.12.132s.36110.