Low molecular weight heparin therapy for percutaneous coronary intervention: A practice in evolution

Unfractionated heparin (UFH) remains the principal antithrombotic agent dur ing percutaneous coronary intervention (PCI) but is associated with signifi cant limitations including an unpredictable anticoagulation dose response, the requirement for frequent monitoring, and transient rebound hypercoagula bility. Low molecular weight heparin (LMWH) represents an attractive altern ative due to its predictable dose response relationship, superior antithrom botic efficacy and potential for improved clinical safety, and has been use d increasingly in patients with acute coronary syndromes prior to coronary angiography. The rationale and existing data regarding the use of LMWH in P CI is summarized and reviewed. Preliminary clinical guidelines for the use of LMWH in the transition from medical stabilization of patients with acute coronary syndromes to invasive management in the catheterization laborator y are presented.