USEFULNESS AND TOLERABILITY OF HIRULOG, A DIRECT THROMBIN-INHIBITOR, IN UNSTABLE ANGINA-PECTORIS

In an open-label pilot study of 20 patients with unstable angina (Brau nwald class I-IIIB), hirulog was administered as a continuous intraven ous infusion for 5 days in a dose of 0.2 mg/kg/hour to produce an acti vated partial thromboplastin time of approximately 200% of control. Th e primary end points of the study were: death, development of a transm ural myocardial infarction, and intractable angina needing interventio ns such as an intraaortic balloon pump insertion, angioplasty and surg ery. The secondary end points were the presence of an intracoronary th rombus detected on angiography and hemorrhagic complications during th erapy. There was no death or transmural infarction in this study cohor t; however, 1 patient developed intractable angina. Intracoronary thro mbus was documented in 2 patients. Infusion of hirulog resulted in a s teady prolongation of the activated partial thromboplastin time withou t any hemorrhagic or other adverse effect. Hirulog appears to be an ef fective antithrombotic agent that is tolerated well and may have advan tages over heparin in the management of patients with unstable angina.