Low-molecular-weight heparin should replace unfractionated heparin in the management of acute coronary syndromes

Acute coronary syndromes (unstable angina and non-Q-wave myocardial infarct ion) are caused by the rupture of an atherosclerotic plaque, platelet activ ation, and fibrin deposition, resulting in thrombosis. Aspirin and unfracti onated heparin (UFH) have traditionally been the treatment of choice in pat ients with acute coronary syndromes. Low-molecular-weight heparins (LMWHs) offer potential advantages over UFH and have been shown to be equally effec tive as UFH for the treatment and prevention of many venous thromboembolic processes. Results of prospective, randomized, controlled trials evaluating the role of LMWH in the management of patients with unstable angina or non -Q-wave myocardial infarction have indicated improved outcomes when compare d with UFH. In addition, despite the increased acquisition cost of LMWH com pared with UFH, an overall cost saving was associated with LMWH use, primar ily as a result of a reduction in cardiovascular events. The available evid ence supports improved clinical outcomes, favorable safety profile, and cos t savings associated with LMWH use in the management of unstable angina and non-Q-wave myocardial infarction. Thus, LMWH should replace UFH as the ant ithrombotic agent of first choice in the management of acute coronary syndr omes.