A group of 123 patients took aspirin and a moderate dose of coumarin. In addition, they continued to take the antithrombotic drug heparin until moderate anticoagulation was achieved. This added as many as 66 additional hours of heparin treatment. A group of 128 control patients used only the daily dose of aspirin and had no additional heparin.
Researchers performed a follow-up angiography after three months. Reocclusion occurred in 15 percent of the combined group (19 patients) vs. 28 percent of the aspirin-only group (36 patients). Problem-free survival was also significantly higher in the combined group 86 percent vs. 66 percent and they had a significantly lower incidence of a second heart attack 2 percent vs. 8 percent.
One side effect of coumarin is a higher risk of bleeding. However, bleeding complications as defined by TIMI criteria occurred in only 5 percent (seven patients) of the combined group vs. 3 percent (four patients) in the aspirin-only group. The difference wasn't statistically significant.
"Since this therapy is rarely available in the United States, our study indicates that maybe newer and more easily applicable oral anticoagulants should also be tested," Verheugt says.
"This is the largest randomized study to date with both clinical and angiographic follow-up addressing the efficacy of a continuous, combined antithrombotic regimen up to three months after a ST-elevation heart attack. However, with respect to the implications for daily clinical practice, we will have to wait for the results of larger trials on this and other antithrombotic regimens."
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Contact: Bridgette Mc Neill
bridgette.mcneill@heart.org
214-706-1135
American Heart Association
15-Jul-2002