Newer antithrombotic agents such as low-molecular-weight heparins, lepirudin, and GP IIb/IIIa inhibitors provide effective alternatives or adjuncts to unfractionated heparin for managing thromboembolic disease and acute coronary syndromes in the ICU.
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May support newer antithrombotics in select ICU cases; leaves open need for RCTs to guide practice.
Thromboembolic disease (TED) is a frequent problem encountered by clinicians in the intensive care unit (ICU). Traditionally, unfractionated heparin (UFH) has been used in the treatment and prophylaxis of TED. However, newer antithrombotic agents have evolved as effective alternatives to UFH. Low-molecular-weight heparins are effective for both the treatment and prophylaxis of TED. Lepirudin is useful for patients with TED and a history of heparin-induced thrombocytopenia. The platelet glycoprotein IIb/IIIa inhibitors are synergistic with UFH for the treatment of acute coronary syndromes and percutaneous coronary interventions (PCI). Several drugs are now available to clinicians for the treatment and prophylaxis of TED.
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Robert J. DiDomenico (2000) studied this question.
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