BENEFIT OF ADDING LOW-MOLECULAR-WEIGHT HEPARIN TO THE CONVENTIONAL TREATMENT OF STABLE ANGINA-PECTORIS - A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL

Background. Patients with chronic coronary artery disease exhibit a dy sfunctioning endothelium, which may be responsible for exercise-induce d platelet activation and expression of a procoagulant moiety. In this study, we evaluated the therapeutic efficacy of a low molecular weigh t heparin (Parnaparin) in patients with stable angina pectoris. Method s and Results. According to a double-blind, randomized, placebo-contro lled trial, 29 patients with stable exercise-induced angina pectoris a nd angiographically proven coronary artery disease received a single d aily subcutaneous injection of Parnaparin or placebo on top of aspirin and conventional antianginal medication over 3 months. Patients rando mized to Parnaparin showed a significant decrease in the fibrinogen le vel (P=.035) and an improvement in both the time to 1-mm ST segment de pression (P.008) and the peak ST segment depression (P=.015). The Cana dian Cardiovascular Society class for angina pectoris was also improve d by Parnaparin (P=.016). Parnaparin did not affect ADP and collagen-i nduced platelet aggregation, whereas thrombin-induced aggregation was reduced (P=.0001). The bleeding time was slightly prolonged, but this was not associated with any significant bleeding. Conclusions. Patient s with stable angina pectoris may be treated with Parnaparin in additi on to aspirin and conventional antianginal medication. Side effects ar e negligible, and compliance is excellent.