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.