Low molecular weight heparins: a valuable tool in the treatment of acute coronary syndromes

Standard heparin, low molecular weight heparin and aspirin are at present the only antithrombotic agents of proven value in the initial treatment of patients with an acute coronary syndrome. The combined use of aspirin and one of the heparins for at least 6 days should be considered for all such patients. With their high bio-availability after subcutaneous injection and prolonged half-life, low molecular weight heparins simplify short-term treatment in the acute phase and enable long-term therapy to be maintained on an outpatient basis without the need for repeated laboratory monitoring of anticoagulant effects. Such long-term therapy would appear to be beneficial, at least in high-risk patients, in the light of increasing evidence that the underlying lesion in acute coronary syndromes resolves over a period of weeks or months.