Title: Antithrombotic treatment of unstable angina – unfractionated heparin or low-molecular-weight heparins?
- Krystyna Zawilska, Stanisław Łopaciuk
- Editorial article
- Polish Journal of Cardiology
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- Final page:
- unstable ischemic heart disease, antithrombotic therapy, unfractionated heparin, low-molecular-weight heparins
Low-molecular-weight heparins are manufactured from unfractionated heparin by chemical or enzymatic depolymerization. In comparison to the parent compound, these drugs have an increased bioavailability following subcutaneous administration, a longer plasma half-life, and more predictable anticoagulant response. Therefore, they can be given subcutaneously in fixed doses once or twice daily. Randomized clinical trials have demonstrated that low-molecular-weight heparins are at least as effective and safe as unfractionated heparin in the treatment of unstable angina and non-Q wave myocardial infarction. Some of them (ESSENCE, TIMI 11b) have shown an apparent advantage of low-molecular-weight heparin – enoxaparin – over unfractionated heparin in these patients. In spite of higher cost of low-molecular-weight heparins, the total cost of the in-hospital period is reduced with their use, mainly because of the reduction in hospital length of stay, the reduction in nursing time, no need for laboratory monitoring of blood samples and reduction in the use of diagnostic catheterization and coronary angioplasty. Low-molecular-weight heparins represent a significant development in antithrombotic therapy.