July 7, 2004

Fractionating Heparins and Their Clinical Trial Data—Something for Everyone

Author Affiliations

Author Affiliations: Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington.

JAMA. 2004;292(1):101-103. doi:10.1001/jama.292.1.101

Heparin, a glycosaminoglycan of varying polysaccharide units and molecular weights, has been shown to reduce ischemic events beyond that of aspirin alone in the setting of an acute coronary syndrome (ACS).1 This benefit translated into a class I indication for unfractionated heparin in the 2000 American College of Cardiology/American Heart Association (ACC/AHA) treatment guidelines for non–ST-segment elevation ACS.2 Unfractionated heparin has several known limitations, however, including a narrow therapeutic window, poorly predictable kinetics, platelet activation, and inability to inhibit clot-bound thrombin.