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October 27, 1988New England Journal of Medicine

Aspirin, Heparin, or Both to Treat Acute Unstable Angina

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Why the study?

Does aspirin, heparin, or both reduce refractory angina, myocardial infarction, and death in patients with acute unstable angina?

Population

479 patients with acute unstable angina pectoris, admitted to hospital

Comparison

Aspirin, heparin, or a combination of the two… vs Placebo

Design

RCT, randomized, double-blind, placebo-controlled

Follow-up

6 +/- 3 days

Authors

PTPierre ThérouxHOHélène OuimetJMJohn McCans

Discussion

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Overview

Supports aspirin or heparin in acute unstable angina to reduce MI; confirms antithrombotic benefit as standard care.

Key Points

  • This trial aims to evaluate the effectiveness of aspirin and heparin in treating acute unstable angina.
  • Conducted a double-blind, randomized, placebo-controlled trial with 479 patients.
  • Interventions included aspirin (325 mg twice daily), heparin (1000 units/hour IV), and their combination.
  • Patients were treated shortly after admission for unstable angina, with a follow-up period of 6 days.
  • Heparin reduced refractory angina occurrence (P = 0.002).
  • Myocardial infarction occurred in 3% with aspirin (P = 0.01), 0.8% with heparin (P < 0.001), and 1.6% with aspirin plus heparin (P = 0.003).
  • No deaths occurred in the aspirin or heparin groups, but bleeding was more frequent with combined treatment (3.3% vs. 1.7%).

Structured PICO

Does aspirin, heparin, or both reduce refractory angina, myocardial infarction, and death in patients with acute unstable angina?

P
Population
479 patients with acute unstable angina pectoris, admitted to hospital (mean 7.9 +/- 8.0 hours after last episode of pain)
I
Intervention
Aspirin (325 mg twice daily), heparin (1000 units per hour by intravenous infusion), or a combination of the two for 6 +/- 3 days
C
Comparator
Placebo
O
Outcome
Major end points: refractory angina, myocardial infarction, and deathhard clinical

In the acute phase of unstable angina, treatment with either aspirin or heparin significantly reduces the incidence of myocardial infarction, with heparin also reducing refractory angina.

Limitations

  • Too few deaths overall to permit evaluation of the effect of treatment on this end point

Cite This Study

Théroux et al. (1988) studied this question.

synapsesocial.com/papers/6a0f12c853f874f2b22321cdhttps://doi.org/10.1056/nejm198810273191701
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effect of Heparin and Heparin Fractions on Platelet Aggregation1980 · 598 citations
  2. 2Coronary artery thrombosis in patients with unstable angina.1981 · 167 citations
  3. 3Protective Effects of Aspirin against Acute Myocardial Infarction and Death in Men with Unstable Angina1983 · 1,717 citations
  4. 4Platelet Activation in Unstable Coronary Disease1986 · 1,150 citations
  5. 5Preinfarctional (Unstable) Angina—A Prospective Study— Ten Year Follow-Up1973 · 393 citations