Non–ST-segment elevation acute coronary syndrome (NSTE-ACS) affects over 500 000 patients in the United States each year. This condition spans a clinical spectrum from unstable angina pectoris (biomarker negative) to non–ST-segment elevation myocardial infarction (biomarker positive). The syndrome results from disruption of the fibrous cap of an unstable atherosclerotic coronary plaque, leading to thrombus formation and partial or total occlusion of the coronary vessel.
Clinical research has focused on parenteral anticoagulation as a potential therapeutic intervention. Clinical trials1,2 with unfractionated heparin, low-molecular-weight heparin, and the pentasaccharide fondaparinux reported clinical benefit, and consequently clinical practice guidelines recommend the immediate use of these agents in all patients with NSTE-ACS.
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Curfman G. Anticoagulation Therapy in Non–ST-Segment Elevation Acute Coronary Syndrome. JAMA Intern Med. 2019;179(2):195. doi:10.1001/jamainternmed.2018.5946
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