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ANTICOAGULANTS IN THERAPY OF PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ST SEGMENT ELEVATION: WHICH DRUG TO BE CHOSEN?

https://doi.org/10.20996/1819-6446-2008-4-2-66-75

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Abstract

Problem of anticoagulant choice in patients with acute coronary syndrome (ACS) is discussed. Results of the main trials on low-molecular heparin therapy in patients with ACS as well as recommendations of European cardiology society and American heart association are presented. Peculiarities of other therapies (thrombin inhibitors, Ха-factor inhibitors) in ACS are surveyed.

About the Authors

A. L. Komarov
Institute of Cardiology named after A.L.Myasnikov, Russian Cardiological Research Complex of Rosmedtechnology, Moscow
Russian Federation


E. P. Panchenko
Institute of Cardiology named after A.L.Myasnikov, Russian Cardiological Research Complex of Rosmedtechnology, Moscow
Russian Federation


References

1. Antman EM, Anbe DT, Armstrong PW. et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J Am Coll Cardiol 2004;44(3):E1-E211.

2. Fuster V., Fallon J.T., Badimon J.J., Nemerson Y. The unstable atherosclerotic plaque: clinical significance and therapeutic intervention Thromb Hemost 1997; 78 (1): 247-55.

3. McLean J. The thromboplastic action of cephalin. Am J Physiol 1916; 41:250–7.

4. Hirsh J, Raschke R. Heparin and Low-Molecular-Weight Heparin. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(3 Suppl):188S–203S.

5. Cohen M., Adams P., Parry G. et al. Combination antithrombotic therapy in unstable rest angina and non-Q-wave infarction in nonprior aspirin users. Primary end points analysis from the ATACS trial. Antithrombotic Therapy in Acute Coronary Syndromes Research Group. Circulation 1994;89(1):81-8.

6. Oler A, Whooley MA, Oler J, Grady D. Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina. A meta-analysis. JAMA 1996;276:811-5.

7. Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. European Heart J 2007; 28(13): 1598-660.

8. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/NonST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007;50(7):e1–157.

9. Smith SC Jr, Feldman TE, Hirshfeld JW Jr. et al. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2006;113(1):156-75.

10. Weitz J.I. Low molecular weight heparins. N Engl J Med 1997;337(10):688-98.

11. Ardissino D, Merlini PA, Arlens R et al. Tissue factor in human coronary atherosclerotic plaques. Clin Chim Acta 2000;291(2):235-40.

12. Spinler SA, Inverso SM, Cohen M, et al. Safety and efficacy of unfractionated heparin versus enoxaparin in patients who are obese and patients with severe renal impairment: analysis from the ESSENCE and TIMI 11B studies. Am Heart J 2003; 146:33–41

13. Klein W., Buchwald A., Hillis S.E. et al. Comparison of low-molecularweight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Fragmin in unstable coronary artery disease study (FRIC). Circulation 1997;96(1):61-68.

14. FRAXIS study group. 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). Eur Heart J 1999;20: 1553-62.

15. Cohen M, Demers C, Gurfinkel EP, et al, for the Efficacy and Safety of Subcutaneous Enoxaparin in Non–Q-Wave Coronary Events Study Group. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med 1997;337(7):447-52.

16. Antman E.M., McCabe C.H., Gurfinkel E.P. et al. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non–Q-wave myocardial infarction: results of the Thrombolysis In Myocardial Infarction (TIMI) 11B trial. Circulation 1999;100:1593-601.

17. Cohen M, Theroux P, Borzak S, et al; for the ACUTE II Investigators. Randomized double-blind safety study of enoxaparin versus unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes treated with tirofiban and aspirin: the ACUTE II study. The Antithrombotic Combination Using Tirofiban and Enoxaparin. Am Heart J 2002;144(3):470-7.

18. Goodman SG, Fitchett D, Armstrong PW, Tan M, Langer A; Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment (INTERACT) Trial Investigators. Randomized evaluation of the safety and efficacy of enoxaparin versus unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes receiving the glycoprotein IIb/IIIa inhibitor eptifibatide. Circulation 2003;107(2):238-244.

19. Blazing MA, de Lemos JA, White HD, Fox KA, Verheugt FW, Ardissino D, DiBattiste PM, Palmisano J, Bilheimer DW, Snapinn SM, Ramsey KE, Gardner LH, Hasselblad V, Pfeffer MA, Lewis EF, Braunwald E, Califf RM for the A to Z Investigators. Safety and efficacy of enoxaparin vs unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes who receive tirofiban and aspirin: a randomized controlled trial. JAMA 2004; 292: 55-64.

20. Ferguson J.J., Califf R.M., Antman E.M. et al. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA 2004;292(1):45-54.

21. Petersen J.L., Kenneth W.M., Hasselblad V. 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(1):89-96.

22. Katsouras C., Michalis L.K., Papamichael N. et al. Enoxaparin versus tinzaparin in non-ST-segment elevation acute coronary syndromes: results of the enoxaparin versus tinzaparin (EVET) trial at 6 months. Am Heart J 2005;150(3):385-91.

23. Montalescot G., Bal-dit-Sollier C., Chibedi D. et al. Comparison of effects on markers of blood cell activation of enoxaparin, dalteparin, and unfractionated heparin in patients with unstable angina pectoris or nonST-segment elevation acute myocardial infarction (the ARMADA study). Am J Cardiol 2003; 91(8): 925-30.

24. Mahaffey KW, Ferguson JJ. Exploring the role of enoxaparin in the management of high-risk patients with non-ST-elevation acute coronary syndromes: the SYNERGY trial. Am Heart J 2005;149(4 Suppl):S81-90.

25. Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N. Engl J Med 2006;354(14):1464-76.

26. Mehta S.R., Granger C.B., Eikelboom J.W. et al. Efficacy and safety of fondaparinux versus enoxaparin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: results from the OASIS-5 trial. J Am Coll Cardiol 2007;50(18):1742-51.

27. Eikelboom J.W., Mehta S.R., Anand S.S. et al. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation 2006;114(8):774-82.

28. Moscucci M., Fox K.A., Cannon C.P. et al. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2003;24(20):1815-23.

29. Bhatt D.L., Roe M.T., Peterson E.D., Li Y. et al. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA 2004;292(17):2096-104.

30. Fox K.A., Bassand J.P., Mehta S.R. et al. OASIS 5 Investigators. Influence of renal function on the efficacy and safety of fondaparinux relative to enoxaparin in non ST-segment elevation acute coronary syndromes. Ann Intern Med 2007;147(5):304-10.

31. Hulot J.S., Montalescot G., Lechat P. et al. Dosing strategy in patients with renal failure receiving enoxaparin for the treatment of non-STsegment elevation acute coronary syndrome. Clin Pharmacol Ther 2005;77(6):542-52.


For citation:


Komarov A.L., Panchenko E.P. ANTICOAGULANTS IN THERAPY OF PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ST SEGMENT ELEVATION: WHICH DRUG TO BE CHOSEN? Rational Pharmacotherapy in Cardiology. 2008;4(2):66-75. (In Russ.) https://doi.org/10.20996/1819-6446-2008-4-2-66-75

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