HEPARIN IS MORE EFFECTIVE THAN INOGATRAN, A LOW-MOLECULAR-WEIGHT THROMBIN INHIBITOR IN SUPPRESSING ISCHEMIA AND RECURRENT ANGINA IN UNSTABLE CORONARY-DISEASE
K. Andersen et M. Dellborg, HEPARIN IS MORE EFFECTIVE THAN INOGATRAN, A LOW-MOLECULAR-WEIGHT THROMBIN INHIBITOR IN SUPPRESSING ISCHEMIA AND RECURRENT ANGINA IN UNSTABLE CORONARY-DISEASE, The American journal of cardiology, 81(8), 1998, pp. 939-944
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.