What parenteral anticoagulation
should be given?
Four agents are commonly used in acute coronary
syndrome: unfractionated heparin, enoxaparin,
fondaparinux and bivalirudin. The first 3
are indirect agents, whereas bivalirudin is a direct
inhibitor of thrombin. Intravenous unfractionated
heparin is indicated in all scenarios of acute coronary
syndrome, alone or in combination with glycoprotein
IIb/IIIa inhibitors, and should be ad -
ministered when the diagnosis is made.