Enoxaparin and dalteparin in unstable angina: new indication. Enoxaparin: a reference treatment. Dalteparin: no better than unfractionated heparin.

(1) Enoxaparin and dalteparin are the only low-molecular-weight heparins so far approved for the treatment of unstable angina and non Q-wave myocardial infarction. (2) In two trials involving over 7,000 patients with unstable angina or non Q-wave myocardial infarction, the enoxaparin + aspirin combination was more effective than the unfractionated heparin + aspirin combination in reducing the risk of death, myocardial infarction or angina relapse. (3) In the same indication another trial showed no significant difference between the dalteparin + aspirin combination and the unfractionated heparin + aspirin combination on the basis of the same end point. (4) The dose must be calculated precisely according to bodyweight, as there is a severe risk of bleeding if the recommended dose is exceeded. (5) Continued enoxaparin therapy after clinical stabilisation has no supplementary benefit compared with aspirin alone.