PMID- 9475828
OWN - NLM
STAT- MEDLINE
DCOM- 19980311
LR  - 20170214
IS  - 1060-0280 (Print)
IS  - 1060-0280 (Linking)
VI  - 32
IP  - 1
DP  - 1998 Jan
TI  - Low-molecular-weight heparins for acute coronary syndromes.
PG  - 103-10
AB  - OBJECTIVE: To review published literature regarding the use of 
      low-molecular-weight heparins (LMWHs) for the acute coronary syndromes of 
      unstable angina and acute myocardial infarction (MI). METHODS: A MEDLINE search 
      (January 1986-August 1997) was performed to identify all pertinent articles. 
      Selected references from these articles and abstracts of recent clinical trials 
      were also included. DISCUSSION: LMWHs have several distinct advantages over 
      standard unfractionated heparin (UFH). These advantages include convenient once- 
      or twice-daily standardized administration without the need for activated partial 
      thromboplastin time monitoring. While the use of LMWHs as prophylaxis and 
      treatment of venous thromboembolism is fairly well-established, the use of LMWHs 
      for treating acute myocardial ischemia is evolving. Published studies and 
      abstracts have shown LMWHs to be as effective as or more effective than UFH in 
      preventing death, myocardial infarction, and recurrent ischemia in patients with 
      unstable angina or acute MI. The comparative incidence of bleeding between LMWHs 
      and UFH is controversial, with some studies reporting lower or similar rates of 
      bleeding with LMWHs, while one study demonstrated a higher bleeding rate than 
      with UFH. The cost-effectiveness of using LMWHs over UFH for acute coronary 
      syndromes also remains to be established. CONCLUSIONS: LMWHs appear to be as 
      effective as, and potentially more effective than, UFH in preventing 
      complications of acute coronary syndromes. However, further studies are needed to 
      better define the comparative bleeding risks of LMWHs and UFH. This, plus the 
      lack of published peer-reviewed trial results and pharmaco-economic analyses, 
      preclude the recommendation of routinely using LMWHs for treating unstable angina 
      and acute MI at this time.
FAU - Spinler, S A
AU  - Spinler SA
AD  - Philadelphia College of Pharmacy and Science, PA 19104, USA.
FAU - Nawarskas, J J
AU  - Nawarskas JJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Angina, Unstable/*drug therapy
MH  - Drug Monitoring
MH  - Heparin, Low-Molecular-Weight/adverse 
      effects/pharmacokinetics/pharmacology/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Syndrome
RF  - 56
EDAT- 1998/02/26 00:00
MHDA- 1998/02/26 00:01
CRDT- 1998/02/26 00:00
PHST- 1998/02/26 00:00 [pubmed]
PHST- 1998/02/26 00:01 [medline]
PHST- 1998/02/26 00:00 [entrez]
AID - 10.1345/aph.16483 [doi]
PST - ppublish
SO  - Ann Pharmacother. 1998 Jan;32(1):103-10. doi: 10.1345/aph.16483.