Low Molecular Weight Heparin, Regular Heparin or Aspirin on the Treatment of Unstable Angina

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Abstract

Background

Unstable angina is a thrombotic process demanding intense medical treatments. Most of them arecapable to reduce complications but some are associated with serious bleeding. Low molecular-weight heparine (LMWH) seems to be safe and without the need of laboratory monitoring.

Methods

A randomized prospective single-blind study including 167 patients with angina at rest in the last 24 hrs before admission (mean time delay: 6.39 hrs) is reported. Patients were randomized to aspirin 200mg (Group A), aspirin + regular heparin (RH) 400IU/kg/day i.v. (Group B) and aspirin + LMWH (CY216), 214 UIC/kg/anti Xa t. a. d. (Group C). The endpoints were: 1) recurrent angina, 2) AMI, 3) urgent intervention (PTCA, CABG), 4) major bleeding and5) death.

Results

Events were analyzed by a two-tailed chi-square test. Total events were: in group A: 42%, in B: 43.1% and in C: 16.6%. Group C was better than A (odds ratio 3.61 (95% IC, 1.39 to 9.55; p <_ 0.003) and also better than B (odds ratio of 6.59 (95% IC, 2.46 to18.15; p <_ 0.0001). Recurrent angina was present in 32.2% of group A, 43.1% of group B and 16.6% of group C. Group C was better than A (p<_ 0.05) andB (p <_ 0.0001). Non fatal AMI was observed in 6 patients (4 in A and 2 in B). Urgent revascularization procedures were necessary in 8 cases: 2 in groupA, 5 in B and 1 in C. A total of 10 minor bleedings were detected in B and only 1 in C (p = 0.006).

Conclusions

In this study, treatment with LMWH in a high dose plus aspirin had significantly better results thanaspirin alone or associated with RH.