Efficacy and Safety of the Low-molecular Heparin in Treatment and Prevention of the Acute Coronary Syndrome
Journal Title: Lviv Clinical Bulletin - Year 2013, Vol 1, Issue 1
Abstract
Introduction. For a long time, the main medication for treating and preventing of thrombotic complications was unfractionated heparin (UFH). However, despite its high efficiency, UFH has a number of disadvantages and side effects. Significant advantages over UFH are low molecular weight heparins or low molecular weight heparins (LMWH). LMWH is a product of enzymatic or chemical depolymerization of conventional heparin. The low molecular weight fractions of heparin obtained during the polymerization process have new pharmacodynamic properties. Today about 10 drugs of LMWH are used. They are obtained by various methods of depolymerization of UFH, resulting in fractions with a lower molecular weight (from 4000 to 6500 daltons). Aim. To review and analyze the current knowledge about the effectiveness and safety of use of LMWH for the treatment and prevention of acute coronary syndrome. Materials and methods. The content analysis, method of system and comparative analysis, the bibliosemantic method of study of actual scientific researches concerning the efficiency and safety of the use of LMWH for the treatment and prevention of acute coronary syndrome has been used. Comparison of the effectiveness of various preparations of low molecular weight heparins is carried out taking into account the results of multicenter studies. The results indicate that LMWH is an effective and safe remedy for the treatment of acute coronary syndrome and preventing coronary events in patients at different risk levels. LMWH are much less than UFH binding to plasma proteins that can neutralize their antithrombotic activity. The low affinity of LMWH to plasma proteins that neutralize heparin is due to their high bioavailability of low doses and greater predictability of anticoagulant response at high doses. LMWH have longer antithrombotic activity than UFH. While the half-life in blood plasma (T1 / 2) of UFH is, if judged by its activity against factor Xa, 50-60 minutes, T1 / 2 of LMWH after intravenous administration is within 1.5-4.5 hours. Significant duration of antithrombotic effect of LMWH allows them to be assigned once or twice a day. The bioavailability of most of the LMWH after deep subcutaneous injection is about 90.0%, whereas in case of UFH it is 15.0 – 20.0%. All of the considered features of pharmacokinetics and pharmacodynamics of LMFH suggest their undoubted advantage over UFH, which consists in the fact that with both – preventive and therapeutic purpose – subcutaneously constant dose can be administered. In addition, LMWH are resistant to inactivating of factor 4 of thrombocytes and do not increase their arrreation under the influence of various inductors. In the case of LMWH, the frequency of thrombocytopenia is much lower. Conclusions. LMWH is an effective and safe medication of the treatment of acute coronary syndrome and for the preventing of coronary events in patients at different risk levels.
Authors and Affiliations
I. Katerenchuk, O. Katerenchuk
Keywords
Related Articles
- EP ID EP255962
- DOI 10.25040/lkv2013.01.040
- Views 116
- Downloads 0
On the Necessity of Development of the Criteria of Professional Suitability of the Workers with Arterial Hypertension
Introduction. The problem of cardiovascular diseases is one of the most important in medical science and practical public health. The most urgent problem of hypertension is in groups of working population suffering from...
Methodology of the Treatment of Pulmonary Tuberculosis
Introduction. Despite the significant successes of tuberculosis treatment, the epidemiological situation, which practically does not show a probable improvement ща the main epidemiological parameters, remains anxious. Ai...
Left Ventricular Remodeling in Patients with Stable Angina Complicated by Heart Failure with Reduced and Preserved Ejection Fraction
Introduction. Chronic heart failure (СHF) is one of the most common and serious diseases of cardiovascular system, resulting in permanent disability and significantly reducing the length and quality of life. Aim of the s...
Методология лечения туберкулеза легких
Введение. Несмотря на значительные успехи лечения туберкулеза, эпидемиологическая ситуация, при которой практически не наблюдается возможного улучшения основных эпидемиологических параметров, остается тревожной. Цель. По...
Содержание некоторых гуморального-метаболических вазоактивных факторов в крови больных циррозом печени и их зависимость от степени тяжести гепатопульмонального синдрома
Введение. Важной задачей современной гепатологии является изучение синтропичних поражений других органов и систем у больных циррозом печени (ЦП), в том числе и гепатопульмонального синдрома (ГПС). Выяснение его патогенет...