ABSTRACT
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
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Dalteparin , Heparin, Low-Molecular-Weight , Angina, Unstable/drug therapy , Cardiovascular Diseases , Angina, Unstable/physiopathologyABSTRACT
We analyzed 13,456 consecutive cases judged between August 1990 and April 1992. Mortality was registered up to 12 months after judgement. Total incapacity was determined in 4,158 cases (30.9 percent), parcial incapacity in 1,340 (9,9 percent) and minor incapacity in 7,958 (59,1 percent). Osteoarticular diseases were the main cause of disability in 4,460 patients (33,1 percent) and 77,8 percent of patients with malignant tumors were considered as having total incapacity. Mortality was 17 percent among subjects with total incapacity, 1,5 percent among those with partial disability and 1 percent among those with minor disability. The cause of death was related to the main disabling disease in 94 percent of subjects with total incapacity and 66,6 percent of those with partial incapacity. Osteoarticular diseases are the main cause of inability among workers ascribed to a private pension system
Subject(s)
Humans , Disability Evaluation , Work Capacity Evaluation , Severity of Illness Index , Statistics on Sequelae and Disability , Cause of Death , Disabled Persons/classification , Insurance, Disability/standardsABSTRACT
Prognosis of unstable angina pectoris is related to admission EKG changes and prompt symptoms control. The aim of this study was to compare the clinical effects of intravenous diltiazem (DTZ) or nitroglycerin (NTG) in patients with unstable angina pectoris. We studied 43 patients admitted to the hospital with a history of rest angina within the last 48 hours, associated with EKG evidence of ischemia. All subjects received intravenous heparin and oral aspirin, 23 were randomly assigned to receive intravenous DTZ and 20 to recieve intravenous NTG. Both groups had similar baseline features and the endpoints of treatment were recurrence of angina, myocardial infarction, death during hospitalization and secondary side effects. Treatment with DTZ, when compared to NTG, resulted in a significant reduction of recurrent angina (8.7 and 59 percent respectively; p<0.05), number of angina episodes per patient (0.18ñ0.5 and 0.9ñ1.2 respectively; p<0.05) and lower need for dose increment to control symptoms (3 and 9 patients respectively; p<0.05). The most common side effects observed were cephalea with NTG (60 percent of patients) and asymptomatic sinus bradicardia with DTZ (28 percent of patients). In each group, one patient had a myocardial infarction and one patient died. It is concluded that intravenous DTZ reduces myocardial ischemia to a greater extent than NTG and can be safely used in patients with unstable angina pectoris
Subject(s)
Humans , Male , Female , Middle Aged , Diltiazem/pharmacokinetics , Nitroglycerin/pharmacokinetics , Angina Pectoris, Variant/drug therapy , Heparin/administration & dosage , Aspirin/administration & dosage , Injections, Intravenous , Myocardial Infarction/epidemiology , Clinical ProtocolsABSTRACT
En el IAM los criterios de clásicos de reperfusión son la disminución del dolor, la reducción del supradesnivel del ST, las arritmias de reperfusión y la elevación precoz de CPK. Sin embargo, el valor predictivo de ellos es bajo. Evaluamos si la inversión precoz de la onda T (* 24 hrs) en (* 2) derivaciones ECGs contiguas contribuye a predecir permeabilidad de la arteria coronaria del área infartada. Analizamos 60 pacientes consecutivos con IAM y trombólisis sistémica, 33 pts. con IAM anterior y 27 con IAM inferior, estudiados con coronariografía dentro de 5 días de evolución del IAM. La arteria coronaria se encontró permeable en 40 pts. (66,6%) y obstruida en 20 pts. (33,3%). En el análisis univariado los criterios se asociaron a reperfusión fueron la inversión precoz de la onda T (p < 0,001), la reducción del supradesnivel de ST (p = 0,01) y la elevación precoz de CPK (p = 0,015). En el análisis multivariado mediante regresión logística paso a paso sólo la inversión precoz de la onda T fue significativa para predecir permeabilidad de la arteria coronaria del IAM. Concluimos que la inversión precoz de la onda T contribuye a predecir permeabilidad de la arteria coronaria post trombólisis sistémica
