HEPARIN IS MORE EFFECTIVE THAN INOGATRAN, A LOW-MOLECULAR-WEIGHT THROMBIN INHIBITOR IN SUPPRESSING ISCHEMIA AND RECURRENT ANGINA IN UNSTABLE CORONARY-DISEASE

Thrombin has been suggested as one of the main pharmacologic targets i n unstable coronary syndromes. Electrocardiographic signs of ischemia during continuous monitoring convey prognostic information in these pa tients. This study assessed the anti-ischemic and clinical effects of the novel low-molecular weight thrombin inhibitor inogatran in patient s with unstable angina and non-Q-wave infarction without persistent ST -segment elevation on hospital admission. Within 24 hours of the last episode of chest pain, 324 patients were randomized to 72 hours of tre atment with inogatran or heparin, Continuous ST-segment analysis with computerized vectorcardiography was used to monitor ischemia for 24 ho urs. The occurrence of cardiac events during the first 7 days were stu died and compared with ischemic episodes during the initial 24 hours. The heparin-treated patients had less episodes of ischemia (ST vector magnitude [ST-VM]: 1 +/- 2.6 vs 2 +/- 4.5, p <0.001 and ST change vect or magnitude [STC-VM]: 3 +/- 4.7 vs 6 +/- 7.6, p <0.001) than the pati ents receiving inogatran, This was paralleled by a lower incidence of the combined end point of death, nonfatal infarction, refractory or re current angina during the first 7 days for the heparin-treated patient s (35%) compared with the inogatran-treated patients (50%) (p <0.05), Patients who had episodes of ischemia in spite of anti-ischemic therap y were at increased risk of all events studied. Heparin is more effect ive than inogatran in suppressing myocardial ischemia and clinical eve nts at short-term follow-up. Continuous ST-segment monitoring with vec torcardiography identifies nonresponders who are at an increased level of risk. (C) 1998 by Excerpta Medica, Inc.