Issues in antithrombin therapy for UA/NSTEMI

In September 2000, participants at the 4th Annual Experts' Meeting of the International Cardiology Forum convened to discuss guidelines for the management of unstable angina/non-ST-elevation MI, recently published by North American and European task forces. Discussion of new recommendations for antithrombin therapy focused on the role of low-molecular-weight heparin (LMWH). Although most participants found the new guidelines largely consistent with existing data, and sufficiently adaptable to most clinical settings, there was concern that neither task force specified LMWH as the antithrombin of choice for the medical management of these patients. The new guidelines continue to endorse the use of unfractionated heparin, particularly for high-risk patients, despite the evidence for the efficacy of LMWH in this setting. This is largely a consequence of the dominant role assigned to the GP IIb/IIIa inhibitors and to an early interventional strategy. It was generally agreed that more data on the use of LMWH in combination with GP IIb/IIIa antagonists would be helpful, as well as more information to guide the transition from medical management to the cath lab. The optimal duration of antithrombin therapy was also the subject of discussion, particularly for patients unable to undergo immediate revascularization.