Copyright © 2002 by the European Society of Cardiology.
Benefits of extended treatment with dalteparin in patients with unstable coronary artery disease eligible for revascularization
a Department of Medicine and Cardiology, Aarhus University Hospital, Denmark
b Department of Cardiology, Uppsala Cardiothoracic Center, Uppsala, Sweden
c Department of Cardiology, Cardiothoracic Center, University Hospital, Uppsala, Sweden
d Department of Cardiology, The Heart and Lung Centre, Ullevål University Hospital, Oslo, Norway
e Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden
f Department of Cardiology, University Hospital, Linköping, Sweden
revised October 22, 2001; accepted November 7, 2001
Abstract
Aims The FRISC II trial demonstrated that, for patients with unstable coronary artery disease, an early invasive strategy following acute treatment with dalteparin and aspirin, was superior to a more conservative approach. We evaluated whether it is beneficial to extend treatment with dalteparin to patients eligible for revascularization but for whom these procedures are performed after the initial hospital stay.
Methods and Results As a subanalysis of FRISC II, the efficacy and clinical safety of extended dalteparin treatment (5000 or 7500IU.12h–1 to day 90) compared with placebo was assessed in 1601 patients randomized to a non-invasive group who underwent revascularization only when necessary because of recurring symptoms, (re)infarction, or severe ischaemia. By day 90, 440 patients had undergone revascularization: 267 of these procedures occurred during the double-blind period. All patients initially received acute treatment (5–7 days from day 1) with dalteparin (120IU/kg–1 12h–1). The incidence of death and/or myocardial infarction was monitored until revascularization or day 45 and until revascularization or day 90. There was a significant difference in the estimated probability of death and/or myocardial infarction until revascularization or day 90 in favour of dalteparin (log-rank test, P=0·0415) and there was a significant reduction in death and/or myocardial infarction in favour of extended dalteparin treatment at day 45, with a 57% relative risk reduction (P=0·0004). At day 90 the relative risk reduction was 29%. The safety profile of extended dalteparin treatment was similar to that of acute usage.
Conclusion Extended dalteparin treatment for up to 45 days is effective and safe as a bridging therapy for patients with unstable coronary artery disease awaiting revascularization.Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved .
Key Words: Unstable coronary artery disease, dalteparin, extended treatment, non-invasive management, invasive management, PTCA, CABG, anticoagulant
f1 Correspondence: Dr Steen Husted, Department of Medicine and Cardiology, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
References
- Merlini P, Bauer K, Oltrona L. Persistent activation of coagulation mechanism in unstable angina and myocardial infarction. Circulation. 1994;90:61–68
[Abstract/Free Full Text] - Ernofsson M, Strekerud F, Toss H, Abildgaard U, Wallentin L. Low molecular weight heparin reduces the generation and activity of thrombin in unstable coronary artery disease. Thromb Haemost. 1998;79:491–494[Web of Science][Medline]
- Feldman RL. Coronary thrombosis, coronary spasm and coronary atherosclerosis and speculation on the link between unstable angina and acute myocardial infarction. Am J Cardiol. 1987;59:1187–1190[CrossRef][Web of Science][Medline]
- Verheugt FW. Acute coronary syndromes: drug treatments. Lancet. 1999;353:SII20–3
- Lancet. 1996;347:561–568[CrossRef][Web of Science][Medline]
- Klein W, Buchwald A, Hillis SE. Comparison of low-molecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Fragmin in unstable coronary artery disease study (FRIC). Circulation. 1997;96:61–68
[Abstract/Free Full Text] - Theroux P, Waters D, Lam J. Reactivation of unstable angina after the discontinuation of heparin. N Engl J Med. 1992;327:141–145[Abstract]
- Kontny F. Reactivation of the coagulation system: rationale for long-term antithrombotic treatment. Am J Cardiol. 1997;80:55E–60E[CrossRef][Medline]
- Lancet. 1999;354:701–707[CrossRef][Web of Science][Medline]
- Lancet. 1999;354:708–715[CrossRef][Web of Science][Medline]
- Wallentin L, Lagerqvist B, Husted S. Outcome at 1 year after an invasive compared with a non-invasive strategy in unstable coronary-artery disease: the FRISC II invasive randomised trial. Lancet. 2000;356:9–16[CrossRef][Web of Science][Medline]
- Eur Heart J. 2000;21:1406–1432
[Free Full Text] - Unger F. Cardiac Interventions in Europe 1997: Coronary revascularization procedures and open heart surgery. Cor Europeum. 1999;7:177–189
- Cardiovascular diseases in Europe, European registries of cardiovascular diseases and patient management, Sophia Antipolis, France, European Society of Cardiology, 1999
- Wester, PO, Nyberg, L, Meeting report, PTCA-activity in Sweden, Socialstyrelsen, Sweden, 1999
- Eur Heart J. 1999;20:1553–1562
[Abstract/Free Full Text] - Antman EM, McCabe CH, Gurfinkel EP. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial. Circulation. 1999;100:1593–1601
[Abstract/Free Full Text] - Stahle E, Lindahl B. Antithrombotic treatment in patients with unstable coronary artery disease undergoing CABG. Ann Thorac Surg. 2001;71:1748–1756
[Free Full Text]
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