Med Klin
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Inhibition of platelet aggregation with aspirin and anticoagulation with unfractionated heparin can be considered the gold standard treatment of patients with acute coronary syndromes. Replacement of unfractionated heparins by low-molecular weight heparins seem to further improve the cardiovascular risk. Additional treatment with glycoprotein IIb/IIIa receptor blockers led to a further reduction of the clinical event rate, especially in patients undergoing coronary interventions during an acute coronary syndrome (more than 30% relative risk reduction). ⋯ Glycoprotein IIb/IIIa receptor blockers should be used especially during coronary interventions. Antianginal treatment should include nitrates and betablockers. A treatment with statins and ACE-inhibitors should be initiated in the early course of acute coronary syndrome for plaque stabilization.
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[Prevention of thromboembolism with low molecular weight heparin (Dalteparin-Na) in risk pregnancy].
Venous thrombotic events still remain the leading cause of maternal morbidity and mortality. During pregnancy as well as post partum, hemostasis changes also in normal pregnant women. Coagulation is activated and fibrinolysis suppressed, the concentration of particular coagulation factors is increased, while inhibitor potential is decreased. Additionally, the venous blood stream is mechanically hampered by the gravid uterus. As a result of these physiologic changes, the risk of thromboembolism is elevated. The risk increases frequently in women with previous thromboembolic episodes, a family history of thromboembolism, hereditary or acquired thrombotic disorders as well as the appearance of additional exposure prothrombogenic factors such as immobilization, inflammation, and operation. Simultaneous presence of combined prothrombogenic factors conducts a potentiation of the risk of thromboembolism. To avoid thromboembolism or rethromboembolism during pregnancy or puerperium, an individual risk-adapted heparin prophylaxis is indicated. ⋯ The individual thromboembolic prophylaxis with LMWH represents an effective and safe therapy in risk pregnancy with previous thromboembolic events and/or thrombotic disorders. TAT seems to be an effective marker for monitoring of the coagulation activity during pregnancy and puerperium. Under this management, thromboembolic prophylaxis can be optimized.