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[Anticoagulantion and antiaggregation therapy in patients with unstableangina pectoris]
1I. interní klinika Fakulty dĕtského lékarství Univerzity Karlovy, Praha.
Insights
Heparin significantly reduced the incidence and severity of myocardial infarction (MI) in unstable angina patients compared to aspirin with dipyridamole or dextrose. Heparin therapy resulted in fewer Q wave MIs and lower creatine phosphokinase levels.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Unstable angina is a critical condition requiring effective treatment to prevent acute myocardial infarction (MI).
- Current therapeutic strategies aim to mitigate MI risk in high-risk patients.
Purpose of the Study:
- To compare the efficacy of heparin versus aspirin with dipyridamole or 5% dextrose in preventing acute MI in unstable angina patients.
- To evaluate the impact of these treatments on the magnitude of MI as measured by serum creatine phosphokinase (CPK) levels.
Main Methods:
- A randomized trial involving 266 unstable angina patients treated concurrently with isosorbide dinitrate, a beta-blocker, and nifedipine.
- Patients received either heparin, aspirin with dipyridamole, or 5% dextrose for 72 hours post-admission.
- Myocardial infarction incidence, Q wave MI development, and peak serum CPK levels were assessed.
Main Results:
- No significant difference in overall acute MI incidence between groups.
- Heparin group showed significantly lower rates of Q wave MI (3.2%) compared to aspirin/dipyridamole (20%) and control (19%) groups.
- Heparin group had significantly lower peak serum CPK levels (810.5 IU/L) than aspirin/dipyridamole (1229 IU/L) and control (1417 IU/L) groups.
- High-risk patients (protracted anginous pain >45 min, ST depression >1 mm) had a 55% risk of MI within 72 hours.
Conclusions:
- Heparin demonstrates a significant advantage in reducing the incidence of Q wave MI and the overall magnitude of myocardial infarction in unstable angina patients.
- Aspirin with dipyridamole did not show a significant benefit over the control group in preventing Q wave MI or reducing MI severity.
- Identifying high-risk patients is crucial, as they face a substantial risk of infarction despite standard therapy.
Abstract:
Heparin, aspirin with dipyridamol or 5% dextrose were administered to 266 patients admitted to the coronary unit with unstable angina. All patients were concurrently treated with isosorbide dinitrate, a beta-blocker and nifedipine. The number of patients who developed an acute myocardial infarction (IM) during the subsequent 72 hours was comparable in all three groups. However, in the heparin treated group only 3.2% patients developed Q IM, as compared with 20% patients treated with aspirin and dipyridamol (p = 0.005) and with 19% in the control group (p = 0.006). The magnitude of the IM was evaluated according to the highest serum value of creatine phosphokinase. In the heparin treated group its value was 810.5 +/- 538 i.u./l which was significantly less than in the aspirin + dipyridamol group where it was 1229 +/- 829 i.u./l (p = 0.048) and in the control group where it was 1417 +/- 919 i.u./l (p = 0.009). The authors defined the group of patients with a high risk of development of IM who had protracted anginous pain longer than 45 mins. with ST segment depression deeper than 1 mm on the ECG on admission. 55% of these patients developed an infarction in the course of the subsequent 72 hours.