Heparin is Favoured Over Aspirin or the Combination In acute unstable angina pectoris

The efficacy of aspirin, heparin and the combination in acute unstable angina pectoris were compared in a double-blind double-dummy study. 479 patients randomly received an initial oral dose of aspirin 650mg followed by 325mg bid (n = 121), an IV bolus of heparin 5000 U followed by 1000 Ujhour (118), aspirin + heparin (122) or placebo (118) for a mean of 6 days after which definite therapy was selected.

Myocardial infarction occurred in significantly fewer aspirin (3.3%), heparin (0.8%) and aspirin + heparin recipients (1.6%) compared with placebo (11.9%). Refractory angina was significantly decreased with heparin (60%) and aspirin + heparin (53%) compared with placebo (22.9%). No deaths occurred in the active treatment groups. After 3 months, myocardial infarction occurred in 3 aspirin, 4 heparin, 2 aspirin + heparin and 5 placebo recipients. Death occurred in 1, 1, 0 and 4 patients, respectively. Adverse effects included bleeding (20 heparin recipients) and serious bleeding (10) was more frequent with aspirin + heparin therapy. Drug withdrawal was more common among heparin recipients (13) than those not receiving heparin (5).

The authors concluded that ' ... the trends favour heparin first, heparin plus aspirin second, and aspirin third' in the treatment of acute unstable angina. Theroux P, Ouimet H, McCans J. Latour JG, Jolly P, et al Asplfin, hepafln, or both to treat acute unstable angma New England Journal of Med1cine 319 1105·1111, 27 Oct 1988 6070

6 INPHARMA"' 12 Nov 1988 0156·2703j88j1112-0006j0$01.00/0 © ADIS Press