title: Decrease in frequency of anginal episodes by control of thrombin generation with low-dose heparin: a controlled cross-over randomized study.
abstract: Increased thrombin generation is frequently associated with an increase in anginal activity. A cross-over, single-blind, completely randomized study was planned in order to evaluate whether the control of thrombin generation affected the increase in anginal activity. After discharge from the hospital, 24 patients (18 men and 6 women, aged 40 to 69 years) suffering from spontaneous angina were followed up to 12 months and were alternatively treated during two consecutive 6-month periods with calcium heparin, 12,500 IU by the subcutaneous route, or with placebo by the intramuscular route, in addition to the usual antianginal medications. Thrombin generation and clinical activity of angina were assessed every 15 days by measuring fibrinopeptide A (FPA) plasma levels and by grading in three classes (symptomless, mildly symptomatic, and severely symptomatic) the anginal activity on the basis of the number and the time concentration of the ischemic attacks and ECG changes. Low-dose heparin treatment significantly reduced both the FPA plasma level (from 4.1 +/- 3.7 to 2.3 +/- 1.8 ng/ml, p less than 0.001) and the clinical activity of angina. During heparin treatment, the frequency of the observations in the severely and mildly symptomatic classes decreased, respectively, by 53% and by 30%, whereas that in the symptomless class increased by 23% (p less than 0.001) in comparison with the period on placebo. Present results indicate that the control of thrombin generation obtained by low-dose heparin treatment favorably affects the degree of anginal activity in patients with spontaneous angina.
authors.affiliation: Clinica Medica I, University of Florence, Italy.
authors.forename: G G
authors.initials: GG
authors.lastname: Neri Serneri
authors.forename: R
authors.initials: R
authors.lastname: Abbate
authors.forename: D
authors.initials: D
authors.lastname: Prisco
authors.forename: M
authors.initials: M
authors.lastname: Carnovali
authors.forename: A
authors.initials: A
authors.lastname: Fazi
authors.forename: G C
authors.initials: GC
authors.lastname: Casolo
authors.forename: F
authors.initials: F
authors.lastname: Bonechi
authors.forename: P G
authors.initials: PG
authors.lastname: Rogasi
authors.forename: G F
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D005260:Female; D005340:Fibrinogen / Q000097:blood*; D005344:Fibrinopeptide A / Q000097:blood*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011897:Random Allocation; D013927:Thrombosis / Q000188:drug therapy*
chemical_list: D005344:Fibrinopeptide A; D005340:Fibrinogen; D006493:Heparin