PMID- 18303934
OWN - NLM
STAT- MEDLINE
DCOM- 20080708
LR  - 20181025
IS  - 1175-3277 (Print)
IS  - 1175-3277 (Linking)
VI  - 8
IP  - 1
DP  - 2008
TI  - Low-molecular-weight heparins : mechanisms, trials, and role in contemporary 
      interventional medicine.
PG  - 15-25
AB  - The clinical spectrum of acute coronary syndromes (ACS) encompasses unstable 
      angina, non-ST-elevation, and ST-elevation myocardial infarction (STEMI). Within 
      an atherosclerotic plaque, disruption of the endothelium can lead to exposure of 
      tissue factor, with platelet adhesion, activation and aggregation, along with 
      activation of the coagulation cascade, culminating in thrombin formation and the 
      development of a cross-linked fibrin clot at the site of injury. Therapy aimed at 
      blocking thrombin formation is now an integral part of the current cardiovascular 
      guidelines in the treatment of ACS. Although unfractionated heparin (UFH) has 
      been the mainstay of antithrombin therapy in the past, it has numerous clinical 
      and biochemical limitations, including substantial protein binding (leading to 
      inconsistent bioavailability), a need for frequent monitoring and adjustment, 
      unreliable and variable degrees of anticoagulation, significant platelet 
      activation, risk of heparin-induced thrombocytopenia, and the inability to block 
      clot bound thrombin. With all of these limitations of UFH, low-molecular-weight 
      heparins (LMWHs) have emerged as attractive alternatives. This review discusses 
      the mechanism of action of LMWHs, and summarizes available literature concerning 
      the use of LMWHs in a variety of clinical settings. Included in this review is an 
      analysis of both current and prior data showing LMWH is as effective as UFH in 
      the conservative and invasive management of patients with ACS. As well, very 
      recent data are evaluated showing the safety and efficacy of LMWHs used in 
      patients transitioning to the cardiac catheterization laboratory, and in those 
      patients undergoing elective or urgent percutaneous coronary intervention (PCI). 
      We also appraise the literature, along with the very recent studies investigating 
      the use of LMWHs as adjunctive therapy to fibrinolytics in patients with STEMI. 
      Finally, we set forth real-world conclusions concerning the use of LMWHs in 
      contemporary interventional practice, including elective PCI and the treatment of 
      ischemic coronary artery disease in the context of rapid invasive management of 
      ACS.
FAU - Canales, John F
AU  - Canales JF
AD  - Department of Cardiology Research, Texas Heart Institute at St Luke's Episcopal 
      Hospital, Baylor College of Medicine, The University of Texas Health Science 
      Center at Houston, Houston, Texas 77225-0269, USA.
FAU - Ferguson, James J
AU  - Ferguson JJ
LA  - eng
PT  - Journal Article
PT  - Review
PL  - New Zealand
TA  - Am J Cardiovasc Drugs
JT  - American journal of cardiovascular drugs : drugs, devices, and other 
      interventions
JID - 100967755
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Angioplasty, Balloon, Coronary
MH  - Anticoagulants/pharmacology/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/pharmacology/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/drug therapy
RF  - 51
EDAT- 2008/02/29 09:00
MHDA- 2008/07/09 09:00
CRDT- 2008/02/29 09:00
PHST- 2008/02/29 09:00 [pubmed]
PHST- 2008/07/09 09:00 [medline]
PHST- 2008/02/29 09:00 [entrez]
AID - 813 [pii]
AID - 10.2165/00129784-200808010-00003 [doi]
PST - ppublish
SO  - Am J Cardiovasc Drugs. 2008;8(1):15-25. doi: 10.2165/00129784-200808010-00003.