Comparative study of heparin and antiplatelets in treatment of preinfarction angina.
Heparin, aspirin with dipyridamole or placebo were given to 266 patients with pre-infarction angina treated with isosorbide dinitrate, beta blockers and nifedipidine. The number of patients who developed acute myocardial infarction (MI) in the next 72 hours was comparable in all 3 groups. However, patients on heparin developed only 3.2% (2 out of 61) Q MI compared with 20% (20 out of 100, p = 0.005) taking dipyridamole with aspirin and 19% (20 out of 105 on placebo, p = 0.006). Infarctions of patients treated with heparin as assessed by peak of serum creatine kinase (CK) were also smaller (810 +/- 538 IU/1) than in groups taking antiplatelets (1229 +/- 829 IU/1, p = 10.048) or placebo (1417 +/- 919 IU/1, p = 0.009). We defined a subgroup at high risk patients who had prolonged chest pain longer than 45 min and ECG changes with ST segment depression more than 1 mm within 6 hours of admission: 55% of these patients developed acute infarction in the following 72 hours. Aggressive management including coronary angiography and fibrinolysis should be considered in well equipped centers for patients with evolving coronary thrombus in a general hospital, heparin infusion should be part of routine treatment as patients on heparin developed smaller infarctions.
Charvat
J
J
Kuruvilla
T
T
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy*; D000789:Angina, Unstable / Q000188:drug therapy*; D001241:Aspirin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D004176:Dipyridamole / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011897:Random Allocation
D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D006493:Heparin; D001241:Aspirin