Differences among low-molecular-weight heparins: evidence in patients with acute coronary syndromes.

Low-molecular-weight heparins (LMWHs) have shown equivalent or superior efficacy and safety to unfractionated heparin as antithrombotic agents for the treatment of patients with acute coronary syndromes (ACS). In patients with unstable angina and non-ST segment elevation myocardial infarction (MI), many data support the use of the LMWH enoxaparin to reduce cardiovascular events and death. LMWHs also appear more effective than unfractionated heparin in reducing the composite end point of acute MI, recurrent ischemia, or death in patients with ST segment elevation MI, and can also be used effectively in patients undergoing thrombolysis reperfusion and percutaneous coronary intervention. However, the various LMWH preparations should not be used interchangeably. Each LMWH is a pleiotropic biological agent with a unique chemical, biochemical, biophysical, and biological profile, and it displays a unique pharmacodynamic and pharmacokinetic profile. As a result, LMWHs are not equipotent in preclinical assays or equivalent in terms of their clinical efficacy and safety. Therefore, it is essential that new, emerging, generic versions of LMWHs demonstrate clinical equivalence, in specific indications, with the existing approved LMWHs. This article highlights the chemical, biological, and pharmacological differences between the LMWH preparations that may result in different clinical outcomes during the treatment of patients with acute coronary syndromes.

Heparina de baixo peso molecular no tratamento da tromboembolia pulmonar / Low-molecular-weight heparin in the treatment of pulmonary embolism

Este artigo de revisão analisa as propriedades farmacocinéticas das heparinas de baixo peso molecular, compara os resultados do seu uso com heparina não fracionada no tratamento da tromboembolia pulmonar, mostrando que são uma alternativa segura e efetiva. Sugere que as heparinas de baixo peso molecular administradas por via subcutânea uma ou duas vezes ao dia e sem necessidade de monitorização laboratorial freqüente permitem o manejo ambulatorial ou com internação hospitalar breve de alguns casos de tromboembolia pulmonar, resultando em redução de custos e maior satisfação do paciente

Terapêutica antitrombótica nas doenças cardiovasculares: estado atual; Parte I / Antithrombotic therapy in cardiovascular diseases: an up-to-date; Part I

Os autores mostram a importância e aplicaçäo clínica no momento atual dos antiplaquetários, anticoagulantes orais, heparina venosa e subcutânea, heparina de baixo peso molecular e os trombolíticos. Chamam a atençäo quanto à interaçäo necessária entre cardiologistas, hematologistas, angiologistas e cirurgiöes no tratamento antitrobótico.