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Panminerva Medica 2002 June;44(2):115-22

lingua: Inglese

The role of low-molecular-weight heparins in non-ST-segment elevation acute coronary syndromes

Nguyen-Ho P., Levine G. N.

From the Section of Cardiology, Baylor College of Medicine Houston VA Medical Center and The Methodist Hospital, Houston, TX, USA


Acute cor­o­nary syn­dromes are ­believed to be medi­at­ed by ­plaque rup­ture, initi­a­tion of the coag­u­la­tion cas­cade, and plate­let acti­va­tion and aggre­ga­tion. Compared to unfrac­tion­at­ed hep­ar­in, the low molec­u­lar ­weight hep­a­rins pos­sess sev­er­al impor­tant theo­ret­i­cal advan­tag­es for the treat­ment of ­patients ­with ­acute cor­o­nary syn­dromes, includ­ing ­less non-spe­cif­ic bind­ing, resis­tance to inac­ti­va­tion by plate­let fac­tor-4, ­more reli­able anti­co­ag­u­la­tion ­effects, and great­er fac­tor ­anti-Xa activ­ity. Four ­large stud­ies ­have com­pared low-molec­u­lar-­weight hep­ar­in ther­a­py ­with unfrac­tion­at­ed hep­ar­in ther­a­py in ­patients ­with ­acute cor­o­nary syn­dromes. Two stud­ies involv­ing enox­ap­ar­in (Lovenox) ­have dem­on­strat­ed ­that ­this ther­a­py ­results in a low­er inci­dence of ­adverse ­events com­pared to treat­ment ­with unfrac­tion­at­ed hep­ar­in. One ­study of dal­tep­ar­in (Fragmin) and one of nadrop­ar­in (Fraxiparin) ­have dem­on­strat­ed com­par­able ­results ­between ­these low-molec­u­lar-­weight hep­a­rins and unfrac­tion­at­ed hep­ar­in. Several stud­ies of mod­est ­size ­have dem­on­strat­ed ­that low-molec­u­lar-­weight hep­a­rins can be safe­ly com­bined ­with plate­let gly­co­pro­tein IIb/IIIa inhib­i­tors. Ongoing and upcom­ing stud­ies ­should add to cur­rent knowl­edge of the util­iza­tion of low-molec­u­lar-­weight hep­a­rins.

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