LOW-MOLECULAR-WEIGHT HEPARINS IN ACUTE ISCHEMIC SYNDROMES

Thrombus formation and ongoing generation play a major role in the pat hogenesis of unstable angina and myocardial infarction (MI). Unfractio nated heparin is widely used as an adjunctive therapy in the managemen t of acute ischaemic syndromes, bur it has a number of limitations inc luding inter-patient variability, need for monitoring, and the fact th at its use may be associated with thrombocytopenia. Low molecular weig ht heparins have pharmacological and pharmacokinetic properties that m ay result in better clinical outcomes and safety They are easy to admi nister and do not require monitoring. Low molecular weight heparins ha ve been shown to reduce mortality and the incidence of MI and recurren t ischaemia compared with placebo in patients with unstable angina and non-Q-wave MI, and have a more predictable anticoagulant effect than standard unfractionated heparin. They also can be used long term in th e outpatient setting, in the form of self-administered subcutaneous In jections. The clinical relevance of these new developments is still be ing defined in ongoing clinical trials and cost-effectiveness analyses .