Evidence for the Benefits of the Low-Molecular-Weight Heparin Dalteparin in ‘High-Risk’ Patients with Acute Coronary Syndromes
- 13 August 2004
- journal article
- review article
- Published by S. Karger AG in Heart Drug
- Vol. 4 (3), 157-163
- https://doi.org/10.1159/000079751
Abstract
Acute coronary syndrome (ACS) is a clinical emergency that requires urgent assessment. ACS encompasses a variety of clinical symptoms of varying severity, and risk stratification is essential to enable triage of patients to the optimum level of care and specific therapy. The medical treatment of ACS is directed primarily at the dissolution of developing intracoronary thrombi by antiplatelet (e.g. aspirin and clopidogrel) and anticoagulant [e.g. low-molecular-weight heparin (LMWH) and unfractionated heparin] therapy. Recent data from clinical trials have shown that LMWH is at least as effective and safe as unfractionated heparin. Additionally, elevation of biochemical cardiac markers and ST segment changes provide powerful risk stratification tools. Data from the Fragmin during Instability in Coronary Artery Disease and Fragmin and Fast Revascularisation during Instability in Coronary Artery Disease studies have demonstrated that prolonged treatment with the LMWH dalteparin provides significant benefit in clinical outcome in patients stratified as ‘high risk’ by troponin measurement and ST monitoring. While an early invasive strategy is recommended in ‘high-risk’ patients with ACS, dalteparin treatment is also effective and safe for up to 45 days in patients awaiting revascularization, or in those for whom an early invasive treatment is not possible. This paper is a review of the evidence for the use of dalteparin in ACS.Keywords
This publication has 29 references indexed in Scilit:
- ACC/AHA 2002 guideline update for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction—summary articleJournal of the American College of Cardiology, 2002
- Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trialThe Lancet, 2002
- Improving outcomes in acute coronary syndromes-The FRISCII trialClinical Cardiology, 2001
- Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology Recommendations of the Task Force of the European Society of CardiologyEuropean Heart Journal, 2000
- Unfractionated heparin and low-molecular-weight heparin in acute coronary syndrome without ST elevation: a meta-analysisThe Lancet, 2000
- Catabolism in chronic heart failureEuropean Heart Journal, 2000
- Comparison of two treatment durations (6 days and 14 days) of a low molecular weight heparin with a 6-day treatment of unfractionated heparin in the initial management of unstable angina or non-Q wave myocardial infarction: FRAX.I.S. (FRAxiparine in Ischaemic Syndrome)Published by Oxford University Press (OUP) ,1999
- Low-molecular-weight heparins in non–ST-segment elevation ischemia: the ESSENCE trialThe American Journal of Cardiology, 1998
- Cardiac-Specific Troponin I Levels to Predict the Risk of Mortality in Patients with Acute Coronary SyndromesNew England Journal of Medicine, 1996