Elsevier

The Lancet

Volume 371, Issue 9624, 10–16 May 2008, Pages 1559-1561
The Lancet

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Guidelines for anticoagulant use in acute coronary syndromes

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    Sometimes, there are multiple comparators to an intervention, and this raises particular challenges. For example, the European Society of Cardiology makes recommendations for use of anticoagulants in patients with non-ST elevation acute coronary syndromes receiving conservative (noninvasive) management [5]. Fondaparinux receives a 1A, heparin a 1C, and enoxaparin a 2A/B. Presumably, these are recommendations for use of these agents vs. not using any anticoagulants.

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    These guidelines are remarkably similar. However, they differ regarding the recommendations and level of evidence that support the use of 3 of the 4 anticoagulants (11) (Table 4),and also regarding the loading dose of clopidogrel. The ACC/AHA update gives a higher Level of Evidence (LOE) to UFH and enoxaparin (Class Ia), but lower LOE for fondaparinux in conservatively managed patients (Class Ib).

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