Heparin and its derivatives in the treatment of arterial thrombosis: a review

Arterial occlusion due to thrombosis caused by ruptured atherosclerotic plaques has been recognized as a major cause of morbidity and mortality in western populations. Along with chronic heart failure it significantly decreases patient life expectancy. The major goal of treatment remains fast recanalization and acute reocclusion prevention. Direct (antithrombin-independent) thrombin inhibitors can be divided into two main categories: monovalent and bivalent, while antithrombin stimulators represent standard (unfractionated) heparin (UFH) and its depolymerizing products - low molecular weight heparins (LMWH's). Recently a shift to prophylaxis of thromboembolic disease has been advocated. Unlike standard heparin, low-molecular weight heparins do not affect the patient's general coagulation profile. Obviously, the difference in molecular weight results in different pharmacokinetic and pharmacodynamic properties of the agents.