Circulation, Vol 88, 2045-2048, Copyright © 1993 by American Heart Association
P Theroux, D Waters, S Qiu, J McCans, P de Guise and M Juneau
BACKGROUND. Antiplatelet therapy with aspirin and antithrombotic therapy
with heparin both prevent the complications of unstable angina; however, no
definitive data exist on the relative clinical efficacy of the two drugs.
METHODS AND RESULTS. Aspirin (325 mg bid) or heparin (5000-U intravenous
bolus followed by a perfusion titrated to the APTT) were compared in a
double-blind randomized trial of 484 patients in two cohorts enrolled
sequentially. The study was initiated at admission to hospital at a mean of
8.3 +/- 7.8 hours after the last episode of pain. End points were assessed
5.7 +/- 3.3 days later, when the decision for long-term management was
made. Myocardial infarction occurred in 2 (0.8%) of the 240 patients
randomized to heparin and in 9 (3.7%) of the 244 randomized to aspirin (P =
.035), an odds ratio of 0.22 and a risk difference of 2.9% (95% confidence
limits, 0.3% to 5.6%) with heparin. The only death resulted from a
myocardial infarction in an aspirin patient. Survival curves with Cox
logistic regression analysis showed that the improvement in survival
without myocardial infarction with heparin (P = .035) was independent of
other baseline characteristics. CONCLUSIONS. This study documents that
heparin prevents myocardial infarction better than aspirin during the acute
phase of unstable angina.
ARTICLES
Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina
Department of Medicine, Montreal Heart Institute, Canada.
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