Clinical Analysis Of Low Molecular Weight Heparin In Acute Coronary Syndrome

Because of the change of life style, smoking, hypertension,Hyperlipidemia, diabetes and obesity, the morbidity of acute coronarysyndrome is rising every year. The patients with acute coronarysyndrome is getting younger and younger, which has become achallenge to physician, heart physician and emergency doctor. Acutecoronary syndrome encompasses a spectrum of coronary arterydiseases, including unstable angina, ST-elevation myocardialinfarction (STEMI), and non-ST-elevation myocardial infarction(NSTEMI). The pathogenesis of acute coronary syndrome is verycomplicated. Fissuring of atherosclerotic plaque triggers thrombusformation and is the main pathogenetic mechanism. Plaque ruptureexposes flowing blood to subendothelial tissues and to potent stimulithat result in platelet aggregation followed by the generation ofthrombin, which converts fibrinogen to fibrin. Antiplatelet andanticoagulant drugs, therefore, represent the cornerstone of therapy foracute coronary syndrome and have resulted in a substantial reductionin morbidity and mortality. In order to assess the therapeusis effect oflow molecular weight heparins in the patients with acute coronarysyndrome, offer referential suggestion for doctors to chooseanticoagulation drugs, 279 cases of acute coronary syndrome wereanalysed retrospectively in intensive care unit and heart department ofour hospital. The results show that the frequency of angina attack and STdepression of electrocardiogram in B group have obviousimprovement compared with group A during anticoagulation treatment.During a week, recurrent angina was observerd in 41 cases (41.0%) ingroup A, 15 (18.3%) in B group;severe arrhythmia in 3 (3.0%) ingroup A, 1 (1.2%) in group B;non deadly myocardial infarction in 5(5.0%) in group A, 1 (1.2%) in group B;need of percutaneouscoronary intervention in 6 (6.0%) in group A, 2 (2.4%) in group B andheart death in 3 (3.0%) in group A, 1 (1.2%) in group B. Nosignificant difference in group D was observed during treatment ofacute myocardial infarction, compared with group C. In group Dimprovement of chest pain was observed in 73 cases (94.8%),Improvement of ST segment in 74 (96.1%);In group C improvementof chest pain was observed in 19 cases (95%), improvement of STsegment in 19 (95%). During 7 days, post-infarctional angina pectoriswas observerd in 8 cases (40.0%) in group C, 32 (41.6%) in group D;severe arrhythmia in 1 (5.0%) in group C, 4 (5.2%) in group D;acuteleft heart failure in 1 (5.0%) in group C, 4 (5.2%) in group D;heartdeath in 1 (5.0%) in group C, 3 (3.9%) in group D;hemorrhage in 3(15.0%) in group C, 1 (1.3%) in group D;thrombocytopenia in 4(20.0%) in group C, 2 (2.6%) in group D.The reaserch indicate the following conclusions: During thetreatment of the unstable angina, low molecular weight heparin(LMWH) has been found to be effective in reduceing the occurrenceof adverse heart events, such as death and myocardial infarction.During the treatment of acute myocardial infarction, LMWH is thesame effective in reduceing the occurrence of adverse heart events asunfractionated heparin (UFH), but compared to UFH, LMWH has lowoccurrence rate of bleeding and thrombocytopenia.Nowadays, LMWH have been proved to be effective in thetreatment of acute coronary syndrome in the large-scale clinical trials.Meanwhile compared to UFH, LMWH possess several importanttheoretical, including less non-specific blinding, resistance toinactivation by platelet factor-4, more reliable anticoagulation effects,and greater factor anti-Xa activity. There are dalteparin, nadroparinand enoxaparin in clinic. In the treatment guideline of UA andNSTEMI, the results of NICE-1, NICE-2 and EVENT trials suggestenoxaparin has been showed to have a clear advantage over UFH, andcan replace UFH in treating acute coronary syndrome. However,because low-molecular-weight heparins have given the differencesbetween studies in patient selection criteria, design, treatmentstrategies, and efficacy variables, it cannot be concluded that onelow-molecular-weight heparin is superior to another in the acute phaseof treatment.In sum, during the treatment of acute coronary syndrome, thedoctor should choose anticoagulant drugs in accordance with thepatients' situation on the basis of the large-scale clinical trials andtreatment guideline, which will give the patients the best benefit.