REDUCTION OF REINFARCTION AND ANGINA WITH USE OF LOW-MOLECULAR-WEIGHTHEPARIN-THERAPY AFTER STREPTOKINASE (AND HEPARIN) IN ACUTE MYOCARDIAL-INFARCTION

This study examined whether extending the anticoagulation effect of he parin by low-molecular-weight heparin (clexane) can prevent recurrent myocardial ischemic events after acute myocardial infarction (AMI) tre ated by streptokinase. On the fifth day after AMI and after heparin th erapy cessation, 103 patients were randomly assigned to either treatme nt with low-molecular-weight heparin (40 mg subcutaneously per day for 25 days, n=43) or control (no treatment, n=60). All patients were fol lowed carefully for 6 months after the infarction date. A total of 32 patients (31%) sustained a cardiac event during the 6-month observatio n period. There were 12 patients (20%) with reinfarction in the contro l group versus 2 patients (4.6%) in the low-molecular-weight heparin g roup during the first 30 days of the study (p=0.02). One additional pa tient sustained reinfarction at 3 months of follow-up in the control g roup, which yielded a total of 13 patients (21.6%) sustaining reinfarc tion in the control group versus 2 patients (4.6%) in the low-molecula r-weight heparin group during 6 months of follow-up (p=0.01). Angina p ectoris after AMI was diagnosed in 13 control patients (21.6%) versus 4 low-molecular-weight heparin-treated patients (9.3%) (p=0.078) durin g the study period. No major bleeding events were reported in either l ow-molecular-weight heparin-treated or control patients. Among patient s with a recently diagnosed AMI treated by streptokinase, extending th e anticoagulant effect of heparin by continuous treatment with low-mol ecular-weight heparin for 25 days may prevent recurrent coronary event s for at least 1 month.