Title: The role of Iow molecular weight heparins in treatment of acute coronary syndromes with ST segment elevation
- Ewa Rzewuska, Krzysztof Jankowski, Robert Królak, Michał Ciurzyński, Danuta Liszewska-Pfejfer
- type 5
- Polish Journal of Cardiology
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- Final page:
- ST segment elevation myocardial infarction, Iow molecular weight heparins, acute coronary syndromes
Treatment with Iow molecular weight heparins (LMWH) in acute coronary syndromes, including these with ST-segment elevation (STEMI), has been investigated in numerous clinical studies. Better pharmacokinetic properties, simpler administration and better safety profile of LMWH in comparison to unfractionated heparin (UFH) stimulate interest in these agents. The randomized clinical studies aimed to answer the issue of whether adding LMWH as adjunctive therapy to fibrynolysis, would be associated with a better outcome of the patients with STEMI. Theevaluated endpoints were both angiographicfpatencyofthe infarct-related ar-tery) and clinical (death, reinfarction, recurrent ischemia). Several trials have demonstrated LMWH superior to UFH (ASSENT 3, ASSENT 3 PLUS), but several have not confirmed that (HART II, ENTIRE-TIMI 23, ASSENT Plus). Moreover, several studies have reported morę bleeding complications following administration of LMWH, especially in the population of elderly patients. The present guidelines of European Cardiac Society stress upon the necessity of further clinical investigation to establish the role of LMWH in treatment of patients with STEMI, and the American Guidelines accept the use of LMWH as alternative in treatment of patients with STEMI younger than 75 years.