Dalteparin for acute coronary syndromes.
Acute coronary syndromes account for tens of thousands of emergency room visits and cost the United States healthcare system billions of dollars each year. Dalteparin is a low molecular weight heparin (LMWH) recently approved for treatment of unstable angina and non-Q wave myocardial infarction (NQWMI). The LMWHs possess distinct advantages over unfractionated heparin (UFH). Some of these advantages include administration by subcutaneous injection with no intravenous access required; laboratory monitoring of activated partial thromboplastin time (aPTT) is not required; improved side effect profile; and more predictable and consistent anticoagulant response. In conjunction with aspirin, dalteparin was evaluated for the treatment of unstable angina and NQWMI in three large clinical trials. The FRISC study established the value of short-term dalteparin in patients with unstable coronary artery disease, but suggested that treatment with 120 IU/kg subcutaneously twice daily may be required for more than 6 days. The FRIC trial determined there was no difference between dalteparin and UFH in the acute setting for prevention of death or myocardial infarction (MI). Similar to the FRISC trial, the FRIC trial failed to demonstrate a benefit of dalteparin beyond the acute phase. The FRISC II study demonstrated a significant decrease in the composite endpoint of death or MI in the dalteparin group at 30 days, but not at 3 or 6 months. The early protective effects of dalteparin could be used to lower the risk of events in patients waiting for invasive procedures.