Ugo Fabrizio, Ardissino Diego
U.O. di Cardiologia, Dipartimento del Cuore, Azienda Ospedaliero-Universitaria Ospedale Maggiore, Parma.
G Ital Cardiol (Rome). 2006 Dec;7(12):771-9.
Plaque disruption and thrombosis are the most important pathogenetic mechanisms of acute coronary syndrome (ACS). Although unfractionated heparin (UFH) was the standard antithrombotic agent for the treatment of ACS, low-molecular-weight heparins (LMWH) are an effective alternative antithrombotic therapy for its more favorable pharmacokinetic and pharmacodynamic profile, and several clinical advantages. Some studies have assessed LMWH in comparison with UFH in patients with ACS, but enoxaparin is the only LMWH to have demonstrated significant clinical and economic benefits in this setting of patients. A recent meta-analysis of ESSENCE, TIMI 11B trial, INTERACT, A to Z and SYNERGY studies has shown that enoxaparin is more effective than UFH in preventing the combined endpoint of death or myocardial infarction in ACS without ST-segment elevation. Moreover, the results of ENTIRE-TIMI 23, ASSENT-3 and the recent ExTRACT-TIMI 25 have demonstrated that adjunctive antithrombotic therapy with enoxaparin, compared with UFH, reduces the composite endpoint of all-cause mortality or non-fatal reinfarction within 30 days in patients with ST-elevation myocardial infarction who are eligible to receive fibrinolytic therapy.
斑块破裂和血栓形成是急性冠状动脉综合征（ACS）最重要的发病机制。尽管普通肝素（UFH）是治疗ACS的标准抗血栓药物，但低分子量肝素（LMWH）因其更有利的药代动力学和药效学特征以及若干临床优势，是一种有效的替代性抗血栓治疗方法。一些研究评估了ACS患者中LMWH与UFH的对比情况，但依诺肝素是唯一在这类患者中显示出显著临床和经济效益的LMWH。最近对ESSENCE、TIMI 11B试验、INTERACT、A到Z及SYNERGY研究的荟萃分析表明，在预防非ST段抬高型ACS患者死亡或心肌梗死的联合终点方面，依诺肝素比UFH更有效。此外，ENTIRE-TIMI 23、ASSENT-3及最近的ExTRACT-TIMI 25研究结果表明，对于有资格接受溶栓治疗的ST段抬高型心肌梗死患者，与UFH相比，依诺肝素辅助抗血栓治疗可降低30天内全因死亡率或非致命性再梗死的复合终点发生率。
