Unstable angina non ST elevation myocardial infarction unfractionated heparin therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Smita Kohli, M.D.

Overview

Unfractionated heparin is an anticoagulant that has traditionally been used as a cornerstone in the treatment of unstable angina and NSTEMI.

Unfractionated Heparin (UFH)

Mechanism of Action

• Unfractionated heparin exerts its anticoagulant effect by potentiating the action of circulating antithrombin, a proteolytic enzyme that inactivates factor IIa (thrombin), factor IXa, and factor Xa.
• It prevents thrombus propagation but does not lyse existing thrombi.

Clinical Trial Data

• A meta-analysis showed that in aspirin-treated patients with acute coronary syndrome without ST elevation, short-term unfractionated heparin or LMWH halves the risk of myocardial infarction or death.

Dosing

• This is a short acting drug with an anticoagulation half life of 1.5 hrs. Hence, frequent monitoring of the anticoagulant response using activated partial thromboplastin time (APTT) is recommended with titrations made according to a standardized nomogram aiming for an APTT range between 1.5 to 2 times control or 50 to 70 seconds .

Adverse Effects

• Bleeding (specially with elevated APTT)
• Heparin induced thrombocytopenia