PMID- 17976502
OWN - NLM
STAT- MEDLINE
DCOM- 20071213
LR  - 20071102
IS  - 0033-0620 (Print)
IS  - 0033-0620 (Linking)
VI  - 50
IP  - 3
DP  - 2007 Nov-Dec
TI  - The use of antithrombotics for acute coronary syndromes in the emergency 
      department: considerations and impact.
PG  - 167-80
AB  - Evidence-based guidelines for the management of acute coronary syndromes (ACS) 
      identify a central role for unfractionated heparin (UFH) or low-molecular-weight 
      heparin (LMWH). A recent study has suggested that interchanging between UFH and 
      LMWH during the course of treatment may be associated with a worse outcome than 
      continued therapy with either form of heparin. Because this has important 
      implications for physicians in the emergency room, this review examines the 
      current evidence for the efficacy and safety of heparins in ACS. In patients with 
      acute myocardial infarction, several studies have shown that LMWHs represent an 
      effective alternative to UFH as an adjunct to thrombolytic therapy and are not 
      associated with an increased risk of major bleeding. In patients with unstable 
      angina or non-ST-segment elevation myocardial infarction, the ESSENCE (Efficacy 
      and Safety of Subcutaneous Enoxaparin in Non-Q Wave Coronary Events) and TIMI 11B 
      (Thrombolysis in Myocardial Infarction 11B) trials have shown that the LMWH 
      enoxaparin significantly reduces the risk of cardiovascular events, compared with 
      UFH, whereas other trials have shown that the combination of enoxaparin and a 
      glycoprotein IIb/IIIa antagonist is not associated with an excess risk of 
      bleeding. Recently, newer agents such as fondaparinux and bivalirudin have shown 
      equivalent efficacy to the heparins with less bleeding and appear clinically 
      attractive. Care paths for the use of antithrombotic therapy in patients with ACS 
      are presented based on current US management guidelines and available clinical 
      evidence.
FAU - Mukherjee, Debabrata
AU  - Mukherjee D
AD  - Gill Heart Institute and Division of Cardiovascular Medicine, University of 
      Kentucky, Lexington, KY 40536-0200, USA. mukherjee@uky.edu
FAU - Eagle, Kim A
AU  - Eagle KA
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Prog Cardiovasc Dis
JT  - Progress in cardiovascular diseases
JID - 0376442
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Critical Pathways
MH  - *Emergency Service, Hospital
MH  - Evidence-Based Medicine
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Humans
MH  - Practice Guidelines as Topic
MH  - Treatment Outcome
RF  - 36
EDAT- 2007/11/03 09:00
MHDA- 2007/12/14 09:00
CRDT- 2007/11/03 09:00
PHST- 2007/11/03 09:00 [pubmed]
PHST- 2007/12/14 09:00 [medline]
PHST- 2007/11/03 09:00 [entrez]
AID - S0033-0620(07)00077-1 [pii]
AID - 10.1016/j.pcad.2007.08.003 [doi]
PST - ppublish
SO  - Prog Cardiovasc Dis. 2007 Nov-Dec;50(3):167-80. doi: 10.1016/j.pcad.2007.08.003.