Antithrombotics and anticoagulants in coronary syndromes and stroke

The low-molecular-weight heparins (LMWHs) have been proven superior to plac ebo in reducing the incidence of acute coronary ischemic syndromes. Compara tive studies vs. unfractionated heparin have not demonstrated superiority i n favor of the LMWH dalteparin. In the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) trial, enoxaparin was de monstrated to have a benefit over heparin, The results have contributed to a better understanding of the relative efficacy of LMWHs in acute coronary syndromes. A second trial with enoxaparin supported the conclusions of the ESSENCE trial. The antithrombotic effects of LMWHs have also been evaluated for the manage ment of ischemic stroke with varied results. A trial assessing tinzaparin i n acute ischemic stroke has completed enrollment, and its results may shed new light on the use of an LMWH for the management of stroke.