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Parenteral anticoagulants in heart disease: Current status and perspectives (Section II)

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
High on-treatment platelet reactivity

DOI: http://dx.doi.org/10.1160/TH12-06-0403
Issue: 2013: 109/5(May) pp. 769-975
Pages: 769-786

Parenteral anticoagulants in heart disease: Current status and perspectives (Section II)

Position Paper of the ESC Working Group on Thrombosis – Task Force on Anticoagulants in Heart Disease

R. De Caterina (1), S. Husted (2), L. Wallentin (3), F. Andreotti (4), H. Arnesen (5), F. Bachmann (6), C. Baigent (7), K. Huber (8), J. Jespersen (9), S. D. Kristensen (10), G. Y. H. Lip (11), J. Morais (12), L. H. Rasmussen (13), A. Siegbahn (14), F. W. A. Verheugt (15), J. I. Weitz (16)

(1) Cardiovascular Division, Ospedale SS. Annunziata, G. d’Annunzio University, Chieti, Italy; (2) Medical-Cardiological Department, Aarhus Sygehus, Aarhus, Denmark; (3) Cardiology, Uppsala Clinical Research Centre and Department of Medical Sciences, Uppsala University, Uppsala, Sweden; (4) Department of Cardiology, Catholic University, Rome, Italy; (5) Medical Department, Oslo University Hospital, Ulleval, Norway; (6) Department of Medicine, University of Lausanne, Lausanne, Switzerland; (7) Cardiovascular Science, Oxford University,Oxford, UK; (8) 3rd Department of Medicine, Wilhelminenspital, Vienna, Austria; (9) Unit for Thrombosis Research, University of Southern Denmark, Esbjerg, Denmark; (10) Departmentof Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark; (11) Haemostasis Thrombosis Vascular Biology Unit, Centre for Cardiovascular Sciences, City Hospital,Birmingham, UK; (12) Cardiology, Leiria Hospital, Leiria, Portugal; (13) Department of Cardiology, Thrombosis Center Aalborg, Aarhus University Hospital, Aalborg, Denmark; (14) Coagulation and Inflammation Science, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; (15) Cardiology, Medical Centre, Radboud University Nijmegen, Nijmegen, Netherlands; (16) Thrombosis Atherosclerosis Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada

Keywords

Atrial fibrillation, heart disease, coagulation, coronary heart disease, Heart failure, Parenteral anticoagulants

Summary

Anticoagulants are a mainstay of cardiovascular therapy, and parenteral anticoagulants have widespread use in cardiology, especially in acute situations. Parenteral anticoagulants include unfractionated heparin, low-molecular-weight heparins, the synthetic pentasaccharides fondaparinux, idraparinux and idrabiotaparinux, and parenteral direct thrombin inhibitors. The several shortcomings of unfractionated heparin and of low-molecular-weight heparins have prompted the development of the other newer agents. Here we review the mechanisms of action, pharmacological properties and side effects of parenteral anticoagulants used in the management of coronary heart disease treated with or without percutaneous coronary interventions, cardioversion for atrial fibrillation, and prosthetic heart valves and valve repair. Using an evidence-based approach, we describe the results of completed clinical trials, highlight ongoing research with currently available agents, and recommend therapeutic options for specific heart diseases.

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