Volume 187 - Issue 6
Guidelines for the management of acute coronary syndromes 2006
Authors: Constantine N Aroney and Philip Aylward
Med J Aust 2007; 187 (6): 372. || doi: 10.5694/j.1326-5377.2007.tb01292.x
Published online: 17 September 2007
Published online: 17 September 2007
In reply: The guidelines were published to provide clinicians with the most contemporary information on the management of acute coronary syndromes based on the international literature, and may include treatments which are not currently available, officially licensed or available through the Pharmaceutical Benefits Scheme in Australia.
In the context of adjuvant therapy for patients with ST-segment-elevation myocardial infarction (STEMI), the guidelines recommend that antithrombin therapy should be used with fibrin-specific fibrinolytic agents.1 Based on the best evidence available at the time, the guidelines mention two antithrombins, unfractionated heparin and enoxaparin, to be considered for use in this setting. The recommendation for enoxaparin is based on comprehensive evidence of clinical benefit with the regimen of an initial intravenous (IV) bolus dose followed by subcutaneous injections every 12 hours. It is up to individual practitioners to determine whether the IV dose should be provided “off-label” or omitted, based on the evidence and the circumstances of the individual patient and setting.
The issue of superiority of enoxaparin over unfractionated heparin as adjuvant therapy for patients with STEMI is currently being evaluated in light of recent evidence,2 and will be included in a future update of the guidelines.
Competing interests
We are consultants for, advisory committee members of, or receive honoraria, fees for service, or travel assistance (independent of research-related meetings) from, or have research or other associations with the organisations listed: Constantine Aroney — CSL, Merck Sharpe & Dohme, Sanofi-Aventis; Phil Aylward — Sanofi-Aventis, Pfizer, Merck Sharpe & Dohme, Bristol-Myers Squibb, Boehringer Ingelheim, AstraZeneca, Procter & Gamble, Eli Lilly, The Medicines Co, Servier, CSL, Schering Plough.
References
- Acute Coronary Syndrome Guidelines Working Group. Guidelines for the management of acute coronary syndromes 2006. Med J Aust 2006; 184 (8 Suppl): S1-S32.
- Antman EM et al. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med 2006; 354: 1477-1488. 0_BABJBCAJ