Document Detail

Factor Xa inactivation in acute coronary syndrome.
MedLine Citation:
PMID:  18473865     Owner:  NLM     Status:  MEDLINE    
The increasing incidence of patients who develop acute coronary syndrome (ACS) stresses the importance of effective initial treatment to reduce morbidity and mortality. The recommended initial therapeutic regimen for patients with ACS includes both anticoagulants and antiplatelet agents to prevent excessive coronary thrombosis, stroke, and further coronary events. Most commonly, unfractionated heparin (UFH) is used for initial antithrombotic treatment of ACS, despite limited published evidence regarding effectiveness and safety (bleeding complications). Therefore, this treatment regimen is primarily based upon expert opinion rather than evidence-based medicine. Studies addressing the dilemma of effectiveness and increased risk of bleeding when using UFH and low molecular weight heparin (LMWH) in patients with ACS showed superior clinical outcome in patients treated with LMWH. Nevertheless, the concurrent increased risk of bleeding while using anticoagulants is a severe problem and negatively impacts upon clinical outcome. Furthermore, non-hemorrhagic side effects of heparin such as heparin-induced thrombocytopenia (HIT), and skin reactions at the site of subcutaneous injection are reduced but not abolished by replacing UFH with LMWH. The limitations of UFH and LWMH as outlined above provided the impetus for the development of a pentasaccharide, called fondaparinux, which inhibits factor Xa selectively. Fondaparinux has been shown to be as effective as enoxaparin in the prevention of thrombosis in patients undergoing orthopedic surgery and showed similar results compared to enoxaparin or UFH in patients with deep-vein-thrombosis or pulmonary embolism. Recently, a large clinical study addressed the dilemma of the effectiveness and adverse effects of anticoagulation in ACS by comparing fondaparinux and LMWH such as enoxaparin in patients with unstable angina or non ST-segment elevation myocardial infarction (NSTEMI).
Melanie Barantke; Hendrik Bonnemeier
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current pharmaceutical design     Volume:  14     ISSN:  1873-4286     ISO Abbreviation:  Curr. Pharm. Des.     Publication Date:  2008  
Date Detail:
Created Date:  2008-05-13     Completed Date:  2008-07-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602487     Medline TA:  Curr Pharm Des     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1186-90     Citation Subset:  IM    
Medizinische Klinik II, Universität zu Lübeck, Lübeck, Germany.
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MeSH Terms
Acute Coronary Syndrome / drug therapy*
Angina, Unstable / drug therapy
Anticoagulants / adverse effects,  therapeutic use*
Enoxaparin / adverse effects,  therapeutic use
Factor Xa / antagonists & inhibitors*
Hemorrhage / chemically induced
Myocardial Infarction / drug therapy
Polysaccharides / adverse effects,  therapeutic use
Reg. No./Substance:
0/Anticoagulants; 0/Enoxaparin; 0/Polysaccharides; 0/fondaparinux; EC Xa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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