The present and future of heparin, low molecular weight heparins, pentasaccharide, and hirudin for venous thromboembolism and acute coronary syndromes

Abstract

Due to their favorable pharmacologic properties and beneficial clinical effects, low molecular weight heparins (LMWHs) have become the standard of care in the prevention and treatment of venous thromboembolism and have also been extensively studied in the treatment of acute coronary syndromes. Pentasaccharide is the first of a new class of synthetic antithrombotics and has been shown to be superior to LMWH in preventing deep vein thrombosis. Hirudin is the most potent direct thrombin inhibitor and has provided superior antithrombotic efficacy when compared with LMWH. In acute coronary syndromes, however, the antithrombotic activity of hirudin has been compromised by a significant increase in major hemorrhage.