The influence of treatment with low molecular weight heparins (dalteparin, nadroparin) on the clinical course and hemostasis activation markers in patients with unstable angina

Abstract number: P0488

Ryabysh^* E., Shubina† T., Titaeva† E., Dobrovolsky† A., Staroverov† I.

^*Cardiology Research Center, Russia; †Russia

Aim  

To evaluate clinical effectiveness of treatment with low molecular weight heparins (LMWH) and unfractionated heparin (UFH) in patients with unstable angina (UA).

Methods  

We have examined 77 patients with UA (an attack of angina within 48 h before treatment with ST depression >0.1 mV on ECG) treated by heparins for 5 days. Patients in the I group (n = 39) were treated with fragment (dalteparin) 120 IU kg^-1 subcutaneously every 12 h, II group (n = 28) – intravenous UFH (initial bolus 4000 IU with subsequent APTT-controlled infusion), III group (n = 10) – fraxiparin (nadroparin) 86 IU kg^-1 as intravenous bolus with subsequent 86 IU kg^-1 subcutaneously every 12 h. All patients received standard treatment. Levels of double-chain form of factor VII (FVIIa) and d-dimer were measured by ELISA in plasma before treatment and 4 h following its completion. Endpoints included: death, myocardial infarction, revascularization (PTCA or surgical).

Results  

By the 30th day endpoints had been registered as follows – 12 (31%) in the I group, 12 (42.9%) in the II group, and 4 (40%) in the III group. By the 6th month – 19 (48.7%), 17 (64.3%), and 5 (50%), respectively. No cases of major hemorrhage or stroke have been registered in either of the groups. d-dimer and factor VIIa dynamics are represented in the Table below.

Conclusion  

Unfavorable outcomes during the 6-month follow-up were less common in the group of patients with unstable angina treated with fragment than in other groups. Treatment with fragmin decreased plasma d-dimer levels. Levels of factor VIIa exceeded the upper limit of normal values in all groups and no significant changes were observed after treatment in any groups.

Table 1