Anti-thrombotic drugs in the treatment of coronary heart disease: the present situation with aspirin.
The most important clinical studies of acetylsalicylic acid in coronary heart disease are compiled. In early 1970 trials unnecessarily high doses have been used. Since 1980 acetylsalicylic acid was given in a dose of about 1000 mg/day. Trials covering 10,000 patients were performed. Significantly decreased cardiovascular morbidity and mortality in patients with previous myocardial infarction was observed. Side effects were significant, haematemesis occurred in 0.1 per cent of patients per year. In secondary-prevention trials to treat unstable angina, which were performed in USA and Canada, the number of non-fatal myocardial infarctions was reduced by about 50 per cent. The dose applied was once 325 mg/day or four times the same dose. In patients after coronary artery by-pass graft acetylsalicylic acid in a dose of 100 mg/day was clinically effective. The effectiveness of acetylsalicylic acid in secondary prevention is strongly supported by the ISIS-2 (Second international Study of Infarct Survival) trial reported in 1988. 17,000 patients were admitted to the trial. With respect to acetylsalicylic acid they received 160 mg/daily for 4 weeks. In addition the effect of streptokinase 1.5 mega-units i.v. was investigated in a cross over design against placebo. Acetylsalicylic acid in the low dose applied, significantly reduced non-fatal reinfarction. The effect of a combination with streptokinase was additive. Primary prevention trials: British and an American trial among volunteer doctors are not comparable because of differences in design and execution. No decrease in overall mortality rate was observed. Acetylsalicylic acid showed some effectiveness but the results are not conclusive.(ABSTRACT TRUNCATED AT 250 WORDS)
Born
G V
GV
William Harvey Research Institute, St. Bartholomew's Medical College, Charterhouse Square, London, UK.
D000789:Angina, Unstable / Q000188:drug therapy; D001241:Aspirin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000188:drug therapy*; D003328:Coronary Thrombosis / Q000188:drug therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy
D001241:Aspirin