Effect of heparin, aspirin, or alteplase in reduction of myocardial ischaemia in refractory unstable angina.
399 out of 474 inpatients with unstable angina were monitored for 48 h and 97 of these were found to be refractory to conventional antianginal treatments and entered a randomised double-blind study. With the initial protocol heparin infusion or bolus were compared with aspirin; with a modified protocol, heparin infusion, the best of these three treatments, was compared with alteplase. Patients were monitored for 3 days after starting treatment and then observed clinically for 4 more days. On the first days of treatment heparin infusion significantly decreased the frequency of angina (by 84-94%), episodes of silent ischaemia (by 71-77%), and the overall duration of ischaemia (by 81-86%). Heparin bolus and aspirin were not effective. Alteplase caused small (non-significant) reductions on the first day only. Only minor bleeding complications occurred.
Neri Serneri
G G
GG
Clinica Medica I, University of Florence, Italy.
Gensini
G F
GF
Poggesi
L
L
Trotta
F
F
Modesti
P A
PA
Boddi
M
M
Ieri
A
A
Margheri
M
M
Casolo
G C
GC
Bini
M
M
D000284:Administration, Oral; D000368:Aged; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000188:drug therapy*; D000789:Angina, Unstable / Q000150:complications / Q000188:drug therapy*; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D006493:Heparin; D010959:Tissue Plasminogen Activator; D001241:Aspirin