Low molecular weight heparin in acute coronary syndromes - The emergence of dalteparin
Low molecular weight heparin (LMWH) preparations are widely used in the management of patients with arterial thrombotic disorders. In addition to a full complement of anti-ischemic therapy and early revascularization in those patients most likely to benefit, the treatment regimen for management of acute coronary syndromes includes antithrombotic therapin with aspirin and anticoagulation. The selection of a specific LMWH preparation is determined by factors including safety, consistency of anticoagulant effects, monitoring requirements, on site-experiences, ease of use and cost. The LMWH dalteparin (Fragmin®) is an important treatment option for anticoagulation therapy, and has been shown to be both safe and effective in three large-scale clinical trials. Clinical outcomes with daleparin therapy are comparable to those with unfractionated heparin, but without the need for routine coagulation monitoring. While the results of ongoing studies are awaited, combination therapy employing the dalteparin and a platelet glycoprotein IIb/IIIa receptor antagonist may prove to be an ideal antithrombotic strategy for patients with acute coronary syndromes.
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