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CARDIOLOGY

Role of Low-Molecular-Weight Heparin in Invasive Management of Non–ST-Elevation Acute Coronary Syndromes

Assistant Clinical Professor, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University; Clinical Pharmacy Specialist, Department of Pharmacy Services, St. Johns Hospital and Medical Center, Detroit, MI

James S Kalus, PharmD BCPS

Assistant Professor, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University; Clinical Pharmacy Specialist, Department of Pharmacy Services, Henry Ford Hospital, Detroit

Reprints: James S Kalus PharmD BCPS, Department of Pharmacy Practice, Ste. 2190, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Detroit, MI 48201-2427, fax 313/916-1302, jkalus{at}wayne.edu

OBJECTIVE: To review the available literature addressing the role of low-molecular-weight heparin (LMWH) as an alternative to unfractionated heparin (UFH) in percutaneous coronary intervention (PCI) for treatment of non–ST-elevation acute coronary syndromes (NSTEACS).

DATA SOURCES: A MEDLINE search (1966–March 2004) identified pertinent articles using the key words acute coronary syndromes, unstable angina, non–ST-elevation myocardial infarction, low-molecular-weight heparin, enoxaparin, dalteparin, glycoprotein IIb/IIIa receptor antagonists, abciximab, tirofiban, eptifibatide, percutaneous transluminal coronary angioplasty, and percutaneous coronary intervention. The references of these articles were reviewed for additional pertinent references.

STUDY SELECTION AND DATA EXTRACTION: All human trials of LMWH in PCI for treatment of NSTEACS were evaluated. All pertinent studies were included in the review.

DATA SYNTHESIS: Administration of LMWH with or without a glycoprotein IIb/IIIa inhibitor during PCI appears to be similar to UFH in terms of efficacy. LMWH, especially in combination with a glycoprotein IIb/IIIa inhibitor, may increase risk of bleeding compared with UFH.

CONCLUSIONS: Available clinical trials do not provide definitive evidence to suggest superiority of LMWH over UFH when managing NSTEACS during PCI; however, dosing strategies are available if an LMWH is to be used in this setting.

Key Words: acute coronary syndromes, low-molecular-weight heparin, percutaneous coronary intervention

Published Online, November 9, 2004. www.theannals.com, DOI 10.1345/aph.1E176

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-04-038-H01

This article has been cited by other articles:

				J. S Kalus and L. R Moser Evolving Role of Low-Molecular-Weight Heparins in ST-Elevation Myocardial Infarction Ann. Pharmacother., March 1, 2005; 39(3): 481 - 491. [Abstract] [Full Text] [PDF]