Acute coronary syndrome heparin therapy

Drug therapy of acute coronary syndromes including unstable angina and non-Q-wave myocardial infarction includes use of aspirin, heparin and anti-ischaemic drugs and is similar in older patients to other age groups. Activation of platelet thromboxane production in the coronary circulation has been demonstrated in unstable angina. The risk of myocardial infarction or death is reduced by approximately 50% by early aspirin therapy in recommended doses of 160-325 mg per day and continued... 

Acute coronary syndrome IV Bolus, IV Infusion 180 mcg/kg bolus then 2 mcg/kg/min until discharge or coronary artery bypass graft, up to 72 hr. Maximum 15 mg/h. Concurrent aspirin and heparin therapy is recommended. 

Randomized comparison of direct thrombin inhibition versus heparin in conjunction with fibrinolytic therapy for acute myocardial infarction results from the GUSTO-lib Trial. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO-lib) Investigators. J Am Coll Cardiol, 1998.31(7) 1493-8. 

Prophylactic enoxaparin is given subcutaneously in a dosage of 30 mg twice daily or 40 mg once daily. Full-dose enoxaparin therapy is 1 mg/kg subcutaneously every 12 hours. This corresponds to a therapeutic anti-factor Xa level of 0.5—1 unit/mL. Selected patients may be treated with enoxaparin 1.5 mg/kg once a day, with a target anti-Xa level of 1.5 units/mL. The prophylactic dose of dalteparin is 5000 units subcutaneously once a day therapeutic dosing is 200 units/kg once a day for venous disease or 120 units/kg every 12 hours for acute coronary syndrome. The use of LMW heparins is discouraged or contraindicated in patients with renal insufficiency or body weight greater than 150 kg. 

Kereiakes DJ, Montalescot G, Antman EM, et al. Low-molecular-weight heparin therapy for non-ST-elevation acute coronary syndromes and during percutaneous coronary intervention an expert consensus. Am Heart J 2002 144 615-624. 

Petersen JL, Mahaffey KW Hasselblad Y et al, Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-Segment elevation acute coronary syndromes a systematic overview, JAMA 2004 292 89-96. 

Patients with acute coronary syndromes such as acute myocardial infarction and unstable angina remain at risk for recurrent myocardial ischemia despite therapy with antiplatelet agents and heparin. Although first clinical trials indicate a possible use of oral direct TIs for the prevention of cardiovascular events in patients after acute myocardial infarction, the presently available data are still limited and it has not... 

Although the manufacturers of abciximab recommend concurrent therapy with heparin, they also report that there is an increase in the incidence of bleeding. In one study in patients with acute coronary syndrome without early revascularisation, the concurrent use of low-molecular-weight heparin was considered to be one of the factors that increased the risk of bleeding events with abciximab ... 

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