González PH

Language: Spanish
References: 14
Page: 63-68
PDF size: 64.38 Kb.

ABSTRACT

This article reviews the usefulness of heparins in the management of patients with acute coronary syndromes. Low molecular weight heparins have a series of advantages over unfractionted heparins, and evidences show that they are more effective than placebo and equal to unfractionated heparin in diminishing the incidence of acute myocardial infarction or death. Evidences that the effectiveness of the low molecular weight heparins are superior is limited to enoxaparin and the most benefited group is the stratified one as high risk.

REFERENCES

1. THEROUX P, FUSTER V: Acute coronary syndromes: unstable angina and non Q-wave myocardial infarction. Circulation 1998; 97: 1195-206.

2. Fragmin During Instability in Coronary Artery Disease (FRISC study group: Low-molecular- weight heparin during instability in coronary artery disease. Lancet 1996; 347: 561-568.

3. WEITZ JI, HIRSH J: New antithrombotic agents. Chest 1998; 114: 715S-727S.

4. OLER A, WHOOLER MA, OLER J, GRADY D: Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina. JAMA 1996; 276: 811-815.

5. ALMONY GT, LEFKOVITS J, TOPOL EJ: Antiplatelet and anticoagulant use after myocardial infarction. Clin Cardiol 1996; 19: 357-365.

6. WEITZ JI: Low-molecular-weight heparins. N Engl J Med 1997; 337: 688-698.

7. FAREED J, JESKIE W, HOPPENSTEADT D, CLARIZO R, WALENGA JM: Are the available lowmolecular- weight heparin preparations the same? Sem Thromb Hemost 1996; 22: 77-91

8. Fragmin During Instability in Coronary Artery Disease (FRISC study group: Low-molecular- weight heparin during instability in coronary artery disease. Lancet 1996; 347: 561-568.

9. KLEIN W, BUCHWALD A, HILLIS SE, ET AL: For the Fric Investigators: Comparison of lowmolecular- weight heparin with unfractionated heparin acutely and with placebo for six week in the management of unstable coronary artery disease: Fragmin in Unstable Coronary Artery Disease Study (FRIC). Circulation 1997; 96: 61-68.

10. The Fraxis Study Group: Comparison of two treatment duration (6 days and 14 days) of a low molecular weight heparin with a 6 day treatment of unfractionated heparin in the initial management of unstable angina or non-Q wave myocardial infarction: FRAXIS (FRAxiparine in Ischaemin Syndrome). Eur Heart J 1999; 20: 1553-1562.

11. COHEN M, DEMERS C, GURFINKEL EP, ET AL: For the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. A comparison of lowmolecular- weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med 1997; 337: 447-452.

12. ANTMAN EM, MCCABE CH, GURFINKEL EP, ET AL: Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Qwave myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) 11B trial. Circulation 1999; 100: 1593-1601.

13. ANTMAN EM, COHEN M, RADLEY DR, ET AL. For the TIMI-11B and Essence Investigators: Assessment of the treatment effect of enoxaparin for unstable angina/non-Q wave myocardial infarction: TIMI-11B-ESSENCE meta-analysis. Circulation 1999; 100: 1602- 1608.

14. SANJAY K, PREDIMANK S: Low molecular weight heparin in acute coronary syndrome: evidence for superior or equivalent efficacy compared with unfractionated heparin? J Am Coll Cardiol 2000; 35: 1699-1712.