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| Scanning electron micrograph of human red blood cells, monocyte (orange), T lymphocyte (green), and activated platelets (blue). |
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Anticoagulants
The role of anticoagulants is to minimize the build up of thrombi and to break down existing clots, which is considered an integral component in the management of acute coronary syndromes. Anticoagulants for parenteral use include intravenous unfractionated heparin (UFH), low-molecular weight heparin (LMWH) and hirudin. For oral use, anti-vitamin K drugs are available. A number of other compounds are under clinical investigation.1 |
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Heparin prevents thrombus growth, but does not lyse existing thrombi. LMWH has distinct advantages over UFH. These include decreased binding to plasma proteins and endothelial cells, as well as a dose dependent clearance with a longer half-life that results in a more predictable and sustained anticoagulation with once or twice a day dosing. Additionally, LMWH does not usually require laboratory monitoring. However, it is important to recognize that the pharmacodynamic and pharmacokinetic profiles of different commercial preparations of LMWH vary.1
By contrast, the direct thrombin inhibitors, like hirudin, very specifically block thrombin effects without the need for a cofactor such as antithrombin.1 |
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