ABSTRACT
Acute coronary syndromes are a major cause of morbidity and mortality in Western societies.
The term describes a spectrum from unstable angina, the recently defined non-Q wave
infarction (the Non ST-Elevation Myocardial Infarction [NSTEMI]), to acute transmural
myocardial infarction. With regard to treatment, a series of recently published studies
compared the specific direct thrombin inhibitor hirudin with standard unfractionated
heparin. Initial small studies showed promising results and led to the initiation
of large-scale clinical trials addressing patients with acute coronary syndromes.
However, in these studies, an unacceptably high incidence of serious hemorrhagic complications
prompted safety boards to stop trials. In those studies carried out according to the
protocol, no significant clinical benefit of hirudin over standard heparin was proved.
Here, hirudin has been shown to be equivalent to unfractionated heparin for the treatment
of unstable coronary syndromes with or without ST elevation and as an adjunct to percutaneous
coronary balloon angioplasty. Because of its narrow therapeutic window between clinical
benefit and increased bleeding hazards, hirudin should be used cautiously. For patients
with heparin-induced thrombocytopenia, hirudin is accepted as an important therapeutic
alternative.
KEYWORDS
Unstable coronary syndrome - hirudin - heparin - myocardial infarction - balloon angioplasty
