Antithrombotic therapy in the new millennium - The role of low-molecular-weight heparin

Low-molecular-weight heparins (LMWHs) are among the most rigorously tested agents in the management of thrombo-embolic disease. The evidence is accumulating that they represent a major advance in the management of arterial and venous thrombo-embolism, and within the next year or two they will replace standard heparin for virtually every indication for which heparin is currently indicated. In the management of acute coronary ischaemia, the results indicate that LMWHs are effective in reducing major ischaemic outcomes in patients with unstable angina and non-Q-wave myocardial infarction. In one study, the LMWH enoxaparin was shown to be more effective than heparin. LMWHs are now approved in many countries for the management of acute coronary ischaemia. Their pharmacological and pharmacokinetic characteristics result in their being highly effective antithrombotic agents, and their clinical utility has resulted in important cost savings in both arterial and venous thrombo-embolism.