Which medications in the drug class Low molecular weight heparins are used in the treatment of Acute Coronary Syndrome?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Low molecular weight heparins

LMWH is indicated for treatment of ST-segment elevation myocardial infarction (STEMI) managed medically or with subsequent PCI. It is also indicated as prophylaxis for ischemic complications caused by unstable angina and non–Q-wave myocardial infarction.

Aside from the possible medical benefits of using LMWH in place of unfractionated heparin, advantages of LMWH include ease of administration, absence of need for anticoagulation monitoring, and potential for overall cost savings. Although 3 LMWHs are approved for use in the United States, only enoxaparin is currently approved for use in unstable angina.

Enoxaparin (Lovenox)

Low-molecular-weight heparin (enoxaparin; Lovenox), which is produced by partial chemical or enzymatic depolymerization of unfractionated heparin, binds to antithrombin III, enhancing its therapeutic effect. The heparin–antithrombin III complex binds to and inactivates activated factor X (Xa) and factor II (thrombin). LMWH differs from unfractionated heparin by having a higher ratio of antifactor Xa to antifactor IIa than does unfractionated heparin. Maximum antifactor Xa and antithrombin activities occur 3-5 hours after administration.

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