Enoxaparin in clinical practice and clinical trials of Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS)

Non-ST elevation Acute Coronary Syndrome (NSTE-ACS) is a myocardial ischemic disorder frequently caused by coronary artery plaque rupture and partial or transient vessel occlusion. Platelets and thrombin play pivotal roles in formation and propagation of thrombus at the site of plaque disruption and embolization into the vascular bed. With the outgoing development of antithrombotic, antiplatelet, and mechanical therapies, the management of NSTE-ACS is constantly evolving. Heparins are the cornerstone of antithrombotic therapy in the current management of NSTE-ACS. Unfractionated heparin and fractionated heparins like enoxaparin have been studied in several large clinical trials and found to be effective in reducing death and myocardial infarction rates. For medical management alone or primarily (conservative strategy), enoxaparin has been shown to be superior to unfractionated heparin. With an early invasive strategy providing better clinical outcome compared to a conservative strategy, the paradigm of ACS management has shifted in favor of early (within 48 hours of admission) cardiac catheterization. The effectiveness of enoxaparin compared to unfractionated heparin is now being re-considered in the era of poly-pharmacotherapy and an early invasive strategy for ACS management. We review the role of enoxaparin in the contemporary treatment of NSTE-ACS utilizing recent clinical trial data.