Heparina de bajo peso molecular versus heparina no fraccionada en el tratamiento de la angina inestable / Comparison of low molecular weight heparin and unfractionated heparin in the treatment of unstable angina

RESUMO

Background: Low molecular weight hepartin can be administered by the subcutaneous route and has stable and prolonged antithrombotic effect. These features have prompted clinical essays about its use as an alternative to unfractional heparin in the treatmen of unstable angina. Aim: To compare the clinical effects of low molecular weight heparin and unfractionated conventional heparin in patients with unstable angina or non Q infarction. Patients and methods: Seventy patients (47 male) admitted to the hospital with the diagnosis of unstable angina or non Q acute myocardial infarction were randomly assigned to receive unfractionated intravenous heparin or subcutaneous low molecular weight heparin bid. All received aspirin po and iv nitroglycerin. The incidence of recurrent angina, acute myocardial infarction or a need for emergency surgical revascularization during hospital stay were assessed in both groups. Results: Compared to patients with low molecular weight heparin, patients receiving unfractionated heparin had a higher incidence of recurrent resting angina (23 and 47.75 percent respectively, p< 0.04) and higher need for emergency surgical revascularization (3.3 and 17.5 percent respectively, p< 0.06). Patients treated with unfractionated conventional heparin had a 3 times higher risk of having an adverse cardiovascular event than patients receiving low molecular weight heparin (O.R. 0.33, confidence intervals 0.11-0.58). Conclusions: Low molecular weight heparin is superior to unfractionated conventional heparin in the treatment of unstable angina and non Q acute myocardial infarction