Effect of combination therapy with heparin, phenindione and aspirin after thrombolysis on parameters of hemostasis and clinical course of myocardial infarction

For elaboration of a regimen of anticoagulation therapy able to prevent dev elopment of hypercoagulable state by the end of the Ist week of acute myoca rdial infarction 93 patients were randomized into 2 groups. Patients of gro up 1 (n=46) received heparin for 10 days to prolong thrombin and activated partial thromboplastin time by 1,5-2,5 times. Patients of group 2 (n=47) in addition to heparin received an anticoagulant (phenindione) for 14 days. D ose of phenindione was titrated to keep prothrombin index lowered down to a mean of 60% (confidence interval 55-68%), or to achieve average internatio nal normalized ratio 1,8. All patients received aspirin (0,25 g/day). Compa red with group 1 patients of group 2 had lower fibrinogen level on days 3 ( 3,5+/-0,1 and 3,0+/-01 g/l, p<0,01, respectively) and 6 (4,1+/-0,1 and 3,4/-0,1 g/l, p<0,001, respectively). This was accompanied by significant decr eases of concentration of fibrinogen <<B>>, parameters of orthophenatroline test, and maximal amplitude of thromboelastogram on days 6 and 14 of infar ction. In group 2 there were also significant decreases of erythrocyte sedi mentation rate (on days 6 and 14), white blood cell count (on day 3), durat ion of hyperthermia, and frequency of postinfarction angina. Combination of heparin and phenindione led to lowering of heparin dose and did not cause increase of hemorrhagic complications.