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Pranab Das, MD; David J. Moliterno, MD

JAMA. 2004;292:101-103.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Heparin, a glycosaminoglycan of varying polysaccharide units and molecular weights, has been shown to reduce ischemic events beyond that of aspirin alone in the setting of an acute coronary syndrome (ACS).¹ This benefit translated into a class I indication for unfractionated heparin in the 2000 American College of Cardiology/American Heart Association (ACC/AHA) treatment guidelines for non–ST-segment elevation ACS.² Unfractionated heparin has several known limitations, however, including a narrow therapeutic window, poorly predictable kinetics, platelet activation, and inability to inhibit clot-bound thrombin.

In comparison, enoxaparin, a low-molecular-weight heparin (LMWH), has a higher anti-factor Xa–anti-factor IIa ratio, thereby reducing some of these limitations. For intermediate and longer-term administration as part of medical therapy, enoxaparin has been considered particularly convenient and cost minimizing because it can be given subcutaneously twice daily without the need for routine monitoring. Based on several LMWH studies, including 2 with enoxaparin . . . [Full Text of this Article]

Author Affiliations: Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington.

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