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Low-Molecular-Weight-Heparin before Cardiac Surgery: To Give or Not To Give?

Department of Cardiac Surgery, Alder Hey Children’s Hospital, Liverpool L12 2AP, United Kingdom

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I read with great interest the article by Myhre et al¹ suggesting that preoperative treatment of unstable angina with low-molecular-weight heparin (LMWH) carries a definite risk of postoperative bleeding. They deserve praise for their important contribution to the existing literature. However, like most previous contributions on this subject^2–4 they leave the readers confused on the all important issue: whether to give LMWH before cardiac surgery or not?

LMWH has become an attractive therapy for use during acute coronary syndrome (ACS) because of its potential superior efficacy over unfractionated heparin (UFH), its longer activity, and its subcutaneous route of administration. However, because a significant number of patients . . . [Full Text of this Article]