Evidence for the Benefits of the Low-Molecular-Weight Heparin Dalteparin in ‘High-Risk’ Patients with Acute Coronary Syndromes

Acute coronary syndrome (ACS) is a clinical emergency that requires urgent assessment. ACS encompasses a variety of clinical symptoms of varying severity, and risk stratification is essential to enable triage of patients to the optimum level of care and specific therapy. The medical treatment of ACS is directed primarily at the dissolution of developing intracoronary thrombi by antiplatelet (e.g. aspirin and clopidogrel) and anticoagulant [e.g. low-molecular-weight heparin (LMWH) and unfractionated heparin] therapy. Recent data from clinical trials have shown that LMWH is at least as effective and safe as unfractionated heparin. Additionally, elevation of biochemical cardiac markers and ST segment changes provide powerful risk stratification tools. Data from the Fragmin during Instability in Coronary Artery Disease and Fragmin and Fast Revascularisation during Instability in Coronary Artery Disease studies have demonstrated that prolonged treatment with the LMWH dalteparin provides significant benefit in clinical outcome in patients stratified as ‘high risk’ by troponin measurement and ST monitoring. While an early invasive strategy is recommended in ‘high-risk’ patients with ACS, dalteparin treatment is also effective and safe for up to 45 days in patients awaiting revascularization, or in those for whom an early invasive treatment is not possible. This paper is a review of the evidence for the use of dalteparin in ACS.