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UTILIZING ENOXAPARIN IN THE MANAGEMENT OF ACUTE CORONARY SYNDROME

https://doi.org/10.20996/1819-6446-2018-14-1-131-136

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Abstract

Anticoagulant therapy is widely used in all forms of acute coronary syndrome (ACS) to inhibit the formation of thrombin and/or to inhibit its activity to reduce the risk of thrombotic events (both in primary percutaneous coronary intervention and in the absence of revascularization). Of the entire range of anticoagulants offered by the domestic and foreign pharmaceutical industry, a limited number of drugs of this group are used in the treatment of ACS, in particular, unfractionated heparin and low molecular weight heparin – enoxaparin.

Enoxaparin has a safety profile and clinical efficacy at least comparable to that of unfractionated heparin, and at the same time has a number of obvious advantages, such as a simpler protocol of administration and dosing, does not require routine monitoring of the parameters of the blood coagulation system. In patients with ACS with ST-segment elevation the routine administration of enoxaparin should be considered as an alternative to the standard regimen of unfractionated heparin therapy. In patients with ACS without ST-segment elevation enoxaparin should be used when fondaparinux is unavailable.

About the Authors

O. V. Krikunova
A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation
Olga V. Krikunova – MD, PhD, Assistant, Chair of Clinical Functional Diagnostics, General Medicine Faculty


R. I. Stryuk
A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation
Raisa I. Stryuk – MD, PhD, Professor, Head of Chair of Internal Medicine, Dental Faculty


References

1. Recommendations of the Society of Specialists in Urgent Cardiology Diagnosis and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Part 1. Kardiologiia. 2017;17(8):80-100. (In Russ) [Рабочая группа по подготовке текста рекомендаций: Руда М.Я., Аверков О.В., Панченко Е.П., Явелов И.С. Диагностика и лечение больных c острым коронарным синдромом без подъема сегмента ST электрокардиограммы. Часть 1. Кардиология. 2017;57(8):80-100]. doi: 10.18087/cardio.2017.8.10023.

2. Hirsh J, Anand SS, Halperin JL, et al. Guide to Anticoagulant Therapy: Heparin. A Statement for Healthcare Professionals From the American Heart Association. Circulation. 2001;103:2994-3018. doi: 10.1161/01.CIR.103.24.2994.

3. Antman E., Handin R. Low-Molecular-Weight Heparins. An Intriguing New Twist With Profound Implications. Circulation. 1998;98:287-9. doi: 10.1161/01.CIR.98.4.287

4. Cannon C. Critical Pathway for Unstable Angina and Non-ST Elevation Myocardial Infarction. February 2002. Crit Pathw Cardiol. 2002;1:12-21. doi: 10.1097/HPC.0b013e3181642955.

5. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. doi: 10.1093/eurheartj/ehv320.

6. Cornelli J.F. Human Pharmacokinetics of Low Molecular Weight Heparins. Semin Thromb Hemost. 1999;25(suppl. 3):57-61.

7. Yavelov IS The use of low molecular weight heparins in cardiology. Pharmatec. 2002; 7/8: 60-73. (In Russ.) [Явелов И.С. Применение низкомолекулярных гепаринов в кардиологии. Фарматека. 2002;7/8:60-73].

8. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. doi: 10.1093/eurheartj/ehx393.

9. Montalescot G., Zeymer U., Silvain J. et al., for the ATOLL Investigators. Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. Lancet. 2011;378:693-703. doi: 10.1016/S0140-6736(11)60876-3

10. Liu Z, Silvain J, Kerneis M, et al. Intravenous Enoxaparin Versus Unfractionated Heparin in Elderly Patients Undergoing Primary Percutaneous Coronary Intervention: An Analysis of the Randomized ATOLL Trial. Angiology. 2017;68(1):29-39. doi: 10.1177/0003319716629541.

11. Silvain J., Beygui F., Barthelemy O., et al. Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis. BMJ. 2012;344:e553. doi: 10.1136/bmj.e553.

12. Eikelboom J.W., Anand S.S., Malmberg K., et al. Unfractionated heparin and low-molecular-weight heparin in acute coronary syndrome without ST elevation: a meta-analysis. Lancet. 2000;355:193642. doi: 10.1016/S0140-6736(00)02324-2.

13. Collet J.P., Montalescot G., Lison L., et al. Percutaneous coronary intervention after subcutaneous enoxaparin pretreatment in patients with unstable angina pectoris. Circulation. 2001;103:658-63. doi: 10.1161/01.CIR.103.5.658.

14. Martin J.L., Fry E.T., Sanderink G.J., et al. Reliable anticoagulation with enoxaparin in patients undergoing percutaneous coronary intervention: the pharmacokinetics of enoxaparin in PCI (PEPCI) study. Catheter Cardiovasc Interv. 2004;61:163-70. doi: 10.1002/ccd.10726.

15. Cohen M., Levine G.N., Pieper K.S., et al. SYNERGY Trial Investigators. Enoxaparin 0.3 mg/kg IV supplement for patients transitioning to PCI after subcutaneous enoxaparin therapy for NSTE ACS: a subgroup analysis from the SYNERGY trial. Catheter Cardiovasc Interv. 2010;75(6):928-35. doi: 10.1002/ccd.22340.

16. Murphy S.A., Gibson C.M., Morrow D.A., et al. Efficacy and safety of the low-molecular weight heparin enoxaparin compared with unfractionated heparin across the acute coronary syndrome spectrum: a meta-analysis. Eur Heart J. 2007;28:2077-86. doi: 10.1093/eurheartj/ehm224.


For citation:


Krikunova O.V., Stryuk R.I. UTILIZING ENOXAPARIN IN THE MANAGEMENT OF ACUTE CORONARY SYNDROME. Rational Pharmacotherapy in Cardiology. 2018;14(1):131-136. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-1-131-136

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ISSN 1819-6446 (Print)
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