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Heparin is available for clinical use since the 1950's and has over the last years firmly established its role as the anticoagulant agent of choice in the prevention and treatment of venous thromboembolism as well as in the management of acute coronary syndromes [1]. Heparin anticoagulation, however, has limitations, partly due to the unpredictable bioavailability of the compound and its large inter- and intraindividual biological effect, requiring continuous intravenous infusion, frequent monitoring of anticoagulation and dose adjustments. Furthermore, the present anticoagulant treatment of patients in a number of clinical situations, such as unstable angina, is still associated with unsatisfactory efficacy and safety in a substantial number of patients.Recently, low molecular weight heparins (LMWH's), consisting of low molecular weight fragments of depolymerized heparin, have been introduced [2]. In laboratory studies it was shown that LMWH's have a relatively high anti-factor Xa to anti-factor IIa ratio, which was thought to be beneficial in terms of a better anticoagulant while less hemorraghic potential. Moreover, LMWH's were shown to have a near complete bioavailability and a much more predictable pharmacokinetic and pharmacodynamic effect, rendering frequent laboratory monitoring redundant and enabling fixed dosing based on bodyweight via the subcutaneous route.In clinical studies on the prevention and treatment of venous thromboembolism LMWH's showed at least equal and in some cases superior efficacy and safety as compared to unfractionated heparin [3, 4]. The relatively easy administration of LMWH by once or twice daily subcutaneous administrations has even enabled the home treatment of a large number … * Corresponding author: Tel.: +31 (20) 5669111; fax: +31 (20) 6968833; E-mail m.m.levi@amc.uva.nl

Weight watching in cardiology: low molecular weight heparin for acute coronary syndromes