Ischemia Driven Enoxaparin Therapy in ACS Presenting as Low Risk (IDEAL)

Inclusion Criteria: * Male or female (negative pregnancy test required for females of childbearing potential) ≥ 18 years of age and capable of signing informed consent; * Typical chest discomfort at rest; lasting at least 5 minutes in the prior 24 hours that is highly suggestive of myocardial ischemia and is not explained by trauma or obvious abnormalities on chest x-ray; * Two or more of high-risk clinical features. Exclusion Criteria: * Clear indication for low molecular weight or unfractionated heparin; * Pregnancy; * Increased bleeding risk; * Impaired hemostasis; * Angina from a secondary cause; * Inability to commence ST segment monitoring within 4 hours of study drug initiation; * Uninterpretable ST segment based upon baseline 12-lead ECG; * Any contraindications to treatment with LMWH (or unfractionated heparin), including heparin induced thrombocytopenia, known allergy to heparin, low molecular weight heparin, pork or pork products; * Renal insufficiency or renal dialysis; * A prosthetic heart valve; * Any other clinically relevant serious diseases; * Current evidence of inebriation with alcohol or intoxication resulting from other drug abuse; * Treatment with other investigational agents or devices within the previous 30 days, planned use of investigational drugs or devices, or has previously enrolled in this trial; * Inability to comply with the protocol; * Inability to understand the nature, scope, and possible consequences of the study or is otherwise unable to provide informed consent.