Low molecular weight heparins better than unfractionated heparin in unstable coronary artery disease? Unstable angina pectoris/non-Q wave infarction a partly outpatient clinic condition?

Important theoretical advantages of low molecular weight heparins compared to standard heparin include better inactivation of the coagulation mechanism as well as better bioavailability and pharmacokinetic properties. In patients with unstable angina pectoris/non-Q wave infarction these advantages may translate into a reduced combined risk of death, myocardial infarction, and recurrent angina as well as a reduced risk of bleeding, although data so far are limited. Data on quality of life, cost analysis, and patient compliance are missing. The initial benefit of both heparin and low molecular weight heparins are partly lost after withdrawal of therapy. The simple dosage regimen of low molecular weight heparins would, however, enable to continue therapy for longer periods of time. Long-term trials are in progress to further elucidate this important issue. The simple dosage regimen also would enable earlier discharge from hospital which would unburden crowded clinical departments and might contribute to patients' quality of life.