To the Editor: The guidelines for managing acute coronary syndromes, published in a supplement to the Journal in 2006, provide a readily accessible tool for clinicians to enhance patient care.1 However, unfortunately the recommendations concerning adjunctive anticoagulation in patients with acute coronary syndromes (ACS) are suboptimal.
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- 1. Acute Coronary Syndrome Guidelines Working Group. Guidelines for the management of acute coronary syndromes 2006. Med J Aust 2006; 184 (8 Suppl): S1-S32. <MJA full text>
- 2. Eikelboom JW, Anand S, Malmberg K, et al. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) in unstable angina and non-Q-wave myocardial infarction (NQMI): a meta-analysis. Lancet 2000; 355: 1936-1942.
- 3. Petersen JL, Mahaffey KW, Hasselblad V, et al. Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-segment elevation acute coronary syndromes: a systematic overview. JAMA 2004; 292: 89-96.
- 4. Eikelboom JW, Quinlan DJ, Mehta SR, et al. Unfractionated and low-molecular-weight heparin as adjuncts to thrombolysis in aspirin-treated patients with ST-elevation acute myocardial infarction: a meta-analysis of the randomized trials. Circulation 2005; 112: 3855-3867.
- 5. Yusuf S, Mehta SR, Chrolavicius S, et al. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006; 354: 1464-1476.
- 6. Antman EM, Morrow DA, McCabe CH, et al. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med 2006; 354: 1477-1488.
- 7. Yusuf S, Mehta SR, Xie C, et al. Effects of reviparin, a low-molecular-weight heparin, on mortality, reinfarction, and strokes in patients with acute myocardial infarction presenting with ST-segment elevation. JAMA 2005; 293: 427-435.
- 8. Yusuf S, Mehta SR, Chrolavicius S, et al. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction. JAMA 2006; 295: 1519-1530.
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John Eikelboom has received honoraria and is currently the recipient of research funding from GlaxoSmithKline and Sanofi-Aventis; Graeme Hankey has received honoraria for consulting on advisory boards and speaking at sponsored scientific symposia by Sanofi-Aventis, Bristol-Myers Squibb, Bayer, Boehringer Ingelheim, AstraZeneca, and Pfizer pharmaceuticals; Paul Langton has received honoraria for consulting on advisory boards and speaking at sponsored scientific symposia by AstraZeneca, Bayer, Boehringer Ingelheim, Merck Sharp & Dohme, Pfizer, Sanofi-Aventis, Servier, and Solvay pharmaceuticals.