Issues in antithrombin therapy for UA/NSTEMI

In September 2000, participants at the 4th Annual Experts' Meeting of the I nternational Cardiology Forum convened to discuss guidelines for the manage ment of unstable angina/non-ST-elevation MI, recently published by North Am erican and European task forces. Discussion of new recommendations for anti thrombin therapy focused on the role of low-molecular-weight heparin (LMWH) . Although most participants found the new guidelines largely consistent wi th existing data, and sufficiently adaptable to most clinical settings, the re was concern that neither task force specified LMWH as the antithrombin o f choice for the medical management of these patients. The new guidelines c ontinue to endorse the use of unfractionated heparin, particularly for high -risk patients, despite the evidence for the efficacy of LMWH in this setti ng. This is largely a consequence of the dominant role assigned to the GP I Ib/IIIa inhibitors and to an early interventional strategy. It was generall y agreed that more data on the use of LMWH in combination with GP IIb/IIIa antagonists would be helpful. as well as more information to guide the tran sition from medical management to the cath lab. The optimal duration of ant ithrombin therapy was also the subject of discussion, particularly for pati ents unable to undergo immediate revascularization. (C) 2001 The European S ociety of Cardiology.