medigraphic.com

2004, Número s2

<< Anterior Siguiente >>

Arch Cardiol Mex 2004; 74 (s2)


Síndromes isquémicos coronarios agudos sin elevación del segmento ST: ¿Por qué las heparinas de bajo peso molecular? ¿Por qué enoxaparina?

Juárez HU

Idioma: Español
Referencias bibliográficas: 29
Paginas: 423-428
Archivo PDF: 60.06 Kb.


RESUMEN

Diversos estudios han mostrado que las heparinas de bajo peso molecular son una alternativa segura y eficaz en el tratamiento de los síndromes coronarios agudos. Se muestran las principales diferencias farmacológicas y farmacocinéticas entre heparina no fraccionada y las heparinas de bajo peso molecular, así mismo, los argumentos que indican el por qué no todas las heparinas de bajo peso molecular han mostrado los mismos resultados y las razones por las que su equivalencia y eficacia no las hacen clínicamente comparables, y por ende aplicables a un mismo objetivo clínico. Se presentan los resultados de los principales estudios que muestran porqué son consideradas ahora como un medicamento de primera elección, en los SCA-SEST (sin elevación del segmento ST), otra importante controversia es el tiempo que deben administrarse posterior a un evento coronario agudo, y cuál es el efecto que tienen en combinación con inhibidores de la glucoproteína IIb/IIIa, así mismo se enfatiza su utilidad importante en los grupos de alto riesgo y en el escenario de procedimientos coronarios intervencionistas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Hirsh J, Warkentin TE, Raschke R: Heparin and low molecular weigth heparin. Mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest 1998; 114(Suppl 5): 489S-510S.

  2. Weitz JI: Low molecular weigth heparins. N Engl J Med 1997; 337: 688-98.

  3. White HR: Low molecular weigth heparins: Are they the same? British J Hematology 2003; 121: 12-20.

  4. Turpie AGG: Can we differentiate the low molecular weigth heparins? Clin Cardiol 2000; 23(Suppl I): 14-17.

  5. Nigthtingale SL: From de Food and Drug Administration. JAMA 1993; 270: 1672.

  6. Pentalyse Investigators. The Pentua Study. Eur Heart J 2001; 22: 1716-1724.

  7. The FRAXIS Investigators: (FRAxiparine in ischaemic syndrome). Eur Heart J 1999; 20: 1553-1562.

  8. Antman EM, McCabe CH, Gurfinkel EP: Enoxaparin prevents death and ischaemic events in unstable angina/non-Q-wave myocardial infarction: results of the thrombolysis in acute myocardial infarction (TIMI )11B trial. Circulation 1999; 100: 1593-1601.

  9. Cohen M, Demers C, Gurfinkel EP: A comparison of low molecular heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and safety of subcutaneous enoxaparin in non-Q-wave coronary events study group. N Engl J Med 1997; 337: 447-452.

  10. Klein W, Buchwald A, Hills SE: Comparison of low molecular weigth heparin with unfractionated heparin acutely and with placebo for 6 weeks in management of unstable coronary artery disease study. ( FRIC ) Circulation 1997; 96: 61-68.

  11. Antman EM, Cohen M, Radley D: Assessment of the treatment effect of enoxaparin for unstable angina/non-Q-wave myocardial infarction: TIMI 11B-ESSENCE meta-analysis. Circulation 1999; 100: 1602-1608.

  12. Kahul S, Shah PK: Low molecular weigth heparin in acute coronary syndrome. Evidence for superior or equivalent efficacy compared with unfractionated heparin? Am Coll Cardiol 2000; 35: 1699-1712.

  13. Elkelboom JW, Anand SS, Malmberg K, Weitz JL, Jinsberg JS, Yusuf S: Unfractionated heparin and low molecular weigth heparin in acute coronary syndrome without ST elevation: a meta-analysis. Lancet 2000; 355: 1936-1942.

  14. Michalis LK, Katsouras C, Papamichen N: Enoxaparin versus Tinzaparin in non ST segment elevation acute coronary syndromes. The EVET trial. Am Heart J 2003; 146: 304-310.

  15. Cohen M, Theroux P, Weber S: Combination therapy with tirofiban and enoxaparin in acute coronary syndromes. Int J Cardiol 1999; 71: 273-281.

  16. Cohen M, Theroux P, Borzak S: Randomized double blind safety study of enoxaparin versus unfractionated heparin in patients with non-ST segment elevation acute coronary syndromes treated with tirofiban and aspirin. The ACUTE II study. The antithrombotic combination using tirofiban and enoxaparin. Am Heart J 2002; 144: 470-477.

  17. Ferguson JJ: The use of enoxaparin and Iib/IIIa antagonists in acute coronary syndromes; including PCI: Final results of NICE 3 study. J Am Coll Cardiol 2001; 37(Suppl A): 365ª.

  18. Boersma E, harrington RA, Moliterno DJ: Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomized clinical trials. Lancet 2002; 359: 189-198.

  19. Merlini PA, Bauer KA, Oltrona L: Persistent activation of coagulation mechanism in unstable angina and myocardial infarction. Circulation 1994; 90: 61-68.

  20. Antman EM, Cohen M, McCabeCH, Goodman SG, Murphy SA, Braunwald E: Enoxaparin is superior to unfractionated heparin for preventing clinical events at 1 year follow-up of TIMI 11 B and ESSENCE. Eur Heart J 2002; 23: 308-314.

  21. The FRISC II Investigators: Long term low molecular mass heparin in unstable coronary artery disease: the Frisc II prospective randomized multicentre study. Lancet 1999; 354: 701-707.

  22. The Frisc II Investigators: Invasive compared with non invasive treatment in coronary artery disease: The Frisc II prospective randomized multicentre study: Fragmin and fast revascularization during instability in coronary artery investigators. Lancet 199; 354: 708-715.

  23. Antman EM, Cohen M, Bernink PJ: The TIMI risk score for unstable angina/non ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000; 284: 835-842.

  24. Zilstra F, Hoorntje JC, de Boer MJ: Long term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999; 341: 1413-1419.

  25. Bertrand ME, Simoons M, Fox KA: Management of acute coronary syndromes: Acute coronary syndromes without persistent ST segment elevation; recommendations to the Task Force of European Society of Cardiology. Eur Heart J 2000; 21: 1406-1432.

  26. The thrombolysis in myocardial infarction (TIMI)11A Trial Investigators. Dosing ranging trial of enoxaparin for unstable angina: Results of TIMI 11A. J Am Coll Cardiol 1997; 29: 1474-1482.

  27. Goodman S, Cohen M, Bigonzi F: Randomized trial of low molecular weigth heparin (enoxaparin) versus unfractionated heparin for unstable coronary artery disease: One year results of the ESSENCE study: Efficacy and Safety of Subcutaneous Enoxaparin in non Q wave Coronary Events. J Am Coll Cardiol 2000; 36: 693-698.

  28. Rabah MM, Premmereur J, Graham M: Usefulness of intravenous enoxaparin for percutaneous coronary intervention in stable angina pectoris. Am J Cardiol 199; 84: 1391-1395.

  29. Choussat R, Montalescost G, Collet JP: A unique low dose of intravenous enoxaparin in elective percutaneous coronary intervention. J Am Coll Cardiol 2002; 40: 1943-1950.




2020     |     www.medigraphic.com