Abstract
Anticoagulant therapy is widely used in all forms of acute coronary syndrome (ACS) to inhibit the formation of thrombin and/or to inhibit its activity to reduce the risk of thrombotic events (both in primary percutaneous coronary intervention and in the absence of revascularization). Of the entire range of anticoagulants offered by the domestic and foreign pharmaceutical industry, a limited number of drugs of this group are used in the treatment of ACS, in particular, unfractionated heparin and low molecular weight heparin – enoxaparin. Enoxaparin has a safety profile and clinical efficacy at least comparable to that of unfractionated heparin, and at the same time has a number of obvious advantages, such as a simpler protocol of administration and dosing, does not require routine monitoring of the parameters of the blood coagulation system. In patients with ACS with ST-segment elevation the routine administration of enoxaparin should be considered as an alternative to the standard regimen of unfractionated heparin therapy. In patients with ACS without ST-segment elevation enoxaparin should be used when fondaparinux is unavailable.
Highlights
Anticoagulant therapy is widely used in all forms of acute coronary syndrome (ACS) to inhibit the formation of thrombin and/or to inhibit its activity to reduce the risk of thrombotic events
Of the entire range of anticoagulants offered by the domestic and foreign pharmaceutical industry, a limited number of drugs of this group are used in the treatment of ACS, in particular, unfractionated heparin and low molecular weight heparin – enoxaparin
Первичные конечные точки (все случаи смерти, осложнения ИМ, неудачи процедуры (ЧКВ) или большие кровотечения в течение 30 дней) случились у 126 (28%) больных, получавших эноксапарин, по сравнению с 155 (34%) пациентами в группе нефракционированный гепарин (НФГ), межгрупповые различия по этому параметру оказались статистически недостоверными [относительный риск (ОР) 0,83; 95% доверительный интервал (ДИ) 0,68-1,01; p=0,06]
Summary
Utilizing Enoxaparin in the Management of Acute Coronary Syndrome Olga V. In patients with ACS with ST-segment elevation the routine administration of enoxaparin should be considered as an alternative to the standard regimen of unfractionated heparin therapy. For citation: Krikunova O.V., Stryuk R.I. Utilizing Enoxaparin in the Management of Acute Coronary Syndrome. Rational Pharmacotherapy in Cardiology 2018;14(1) / Рациональная Фармакотерапия в Кардиологии 2018;14(1). Enoxaparin in Acute Coronary Syndrome Эноксапарин при остром коронарном синдроме терапии у пациентов с ОКС во многом определяется положением сегмента ST относительно изоэлектрической линии на ЭКГ: при смещении сегмента ST вверх (подъеме ST) методом выбора восстановления коронарного кровотока является срочная коронарная ангиопластика (чрескожная транслюминальная коронарная ангиопластика [ЧТКА], чрескожное коронарное вмешательство [ЧКВ]), при невозможности проведения которых в соответствующие сроки показана тромболитическая терапия. С практической точки зрения целесообразным стало при первом контакте врача с больным использовать термины ОКС с подъемом и без подъема сегмента ST
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