Author/Editor		Hoechtl, Thomas; Wojta, Johann; Geppert, Alexander; Huber, Kurt
Title		Use of direct and indirect antithrombins in acute coronary syndromes without ST-segment elevation
Translated title		Uporaba neposrednih in posrednih antitrombinov v zdravljenju akutnega koronarnega sindroma brez dviga veznice ST
Type		članek
Source		Slov Kardiol
Vol. and No.		Letnik 2, št. 2
Publication year		2005
Volume		str. 136-41
Language		eng
Abstract		Unfractionated heparin (UFH) as well as low molecular weight heparins (LMWH), especially enoxaparin, are recommended by the current international guidelines for routine use in the conservative treatment of patients with acute coronary syndromes (ACS). UFH is still the recommended antithrombin as soon as percutaneous coronary interventions (PCI) are performed, although the results of different trials have clearly demonstrated the benefit of enoxaparin also in interventional cardiology. Bleeding complications during PCI procedures can be minimized by avoiding crossover from enoxaparin to UFH or vice versa and by reducing the dosage of indirect antithrombins, particularly of enoxaparin, in patients with chronic renal dysfunction and/or the elderly. Especially for these patient groups bivalirudin offers an effective alternative already today. There is increasing expectation concerning the usa of bivalirudin in patients undergoing PCI procedures, but firm data exist at present only for low- and medium risk patients with non-ST elevation ACS. Results of still ongoing trials (ACUITY, HORIZONS) will help to further confirm the role of bivalirudin in patients with high-risk acute coronary syndromes.
Summary		Sodobne smernice priporčajo rutinsko uporabo tako standardnega kot tudi nizkomolekularnega heparina (zlasti enoksaparina) v konzervativni oskrbi bolnikov z akutnim koronarnim sindromom (AKS). Standardni heparin še vedno priporočajo takoj, ko opravimo perkutani koronarni poseg, čeprav so različne raziskave dokazale, da je enoksaparin učinkovit tudi v invazivni kardiologiji. Krvavitve ob perkutanih posegih lahko se lahko preprečimo, če ne izmenjujemo enoksaparina in standardnega heparina ter s prilagajanjem odmerkov posrednih antitrombinov, zlasti enoksaparina, pri bolnikih z ledvično odpovedjo ali pri starostnikih. Pri teh skupinah bolnikov je bivalirudin učinkovit nadomestek. Od bivalirudina si veliko obetamo pri bolnikih, ki potrebujejo perkutani koronarni poseg, vendar je njegova učinkovitost danes dokazana le pri malo in zmerno ogroženih bolnikih z akutnim koronarnim sindromom brez dviga veznice ST. Izsledki raziskav, ki trenutno potekajo (ACUITY, HORIZONS), utegnejo potrditi vlogo bivalirudina tudi pri zelo ogroženih bolnikih z akutnimi koronarnimi sindromi.
Descriptors		CORONARY DISEASE MYOCARDIAL INFARCTION ANGINA, UNSTABLE HEPARIN, LOW-MOLECULAR-WEIGHT HEPARIN ANGIOPLASTY, TRANSLUMINAL, PERCUTANEOUS CORONARY ANTITHROMBINS