Low-molecular-weight heparins and glycoprotein IIb/IIIa antagonists in acute coronary syndromes.

Traditional antithrombotic regimens for the management of acute coronary syndromes are far from optimal. There is considerable opportunity for improvement of standard treatment with unfractionated heparin and aspirin. The introduction of new antithrombotic drugs, such as low-molecular-weight heparins(LMWH), and more potent antiplatelet drugs, such as glycoprotein(GP) lIb/llla antagonists, has the potential to significantly improve clinical outcomes. The complementary anticoagulant/antiplatelet modes of action of LMWHs and GP lIb/Ila antagonists mean that combining these drugs in the medical management of patients with acute coronary syndromes, including those who undergo percutaneous coronary intervention, may offer enhanced clinical benefits. Until recently, there was a lack of clinical data to support this approach, but several recent trials have confirmed the safety and efficacy of combination therapy with the LMWH enoxaparin and a GP lIb/Illa antagonist in the management of patients with unstable angina/non-ST segment elevation myocardial infarction. The 2002 American College of Cardiology/American Heart Association guidelines on unstable angina/non-ST-segment elevation myocardial infarction reflect this new evidence. The combined use of a LMWH and a GP IIb/IIIa antagonist should now be viewed as safe and effective in the management of acute coronary syndromes. Definitive efficacy-powered superiority data will be available shortly.