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Comparative study of heparin and antiplatelets in treatment of preinfarction angina
Insights
Heparin significantly reduced the incidence and size of myocardial infarction (MI) in pre-infarction angina patients. Patients receiving heparin had smaller infarcts compared to aspirin-dipyridamole or placebo groups.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Pre-infarction angina is a critical condition requiring effective management to prevent acute myocardial infarction (MI).
- Optimal antiplatelet and anticoagulant strategies for high-risk patients remain under investigation.
Purpose of the Study:
- To evaluate the efficacy of heparin compared to aspirin with dipyridamole or placebo in patients with pre-infarction angina.
Main Methods:
- A randomized trial involving 266 patients with pre-infarction angina receiving standard treatment.
- Patients were assigned to receive heparin, aspirin with dipyridamole, or placebo.
Main Results:
- Heparin significantly reduced the occurrence of Q-wave MI (3.2% vs. 20% for aspirin-dipyridamole, p=0.005; and 19% for placebo, p=0.006).
- Infarct size, assessed by peak serum creatine kinase (CK), was smaller in the heparin group (810 IU/L) compared to antiplatelet (1229 IU/L, p=0.048) and placebo (1417 IU/L, p=0.009) groups.
- A high-risk subgroup with prolonged chest pain and ECG changes had a 55% infarction rate within 72 hours.
Conclusions:
- Heparin infusion should be considered routine treatment for patients with evolving coronary thrombus in general hospitals.
- Aggressive management, including coronary angiography and fibrinolysis, is recommended for high-risk patients in specialized centers.
Abstract:
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.