Optimising the treatment of patients with acute coronary syndrome without ST segment elevation

Abstract

Aim. To investigate the effects of unfractionated heparin (UFH) and its combination with warfarin on clinical course and plasma hemostasis in patients with acute coronary syndrome (ACS) without ST segment elevation.Material and methods. This prospective, open, randomized study included 174 ACS individuals without ST elevation. Group I (n=100) received UFH intravenously; Group II (n=74) received UFH and warfarin. Additionally, all participants were administered cardiomagnil (300 mg at admission, then 75 mg/d). Standard anti-anginal treatment was also performed. During 150 days after the randomization, the incidence of severe coronary complications and plasma hemostasis were investigated.Results. In patients receiving UFH, a statistically significant decrease in antithrombin (AT) III concentration was observed 1 day after the randomization. UFH reduces the AT III pool, which increases the risk of recurrent angina during and after heparin therapy. In UFH group, a significant increase in soluble fibrin-monomer complex (SFMC) concentration was registered at Day 8. In UFH + warfarin group, no SFMC increase was observed at Day 8, and the adverse coronary event incidence was statistically lower from Day 15 to Day 150, since warfarin prevented the “rebound” effect (thrombosis reactivation).Conclusion. Warfarin prevented the “rebound” effect after the end of heparin treatment (recurrent angina, plasma hemostasis activation, and increased SFMC levels at Day 8).

Keywords

• acute coronary syndrome without st segment elevation
• cardiomagnil
• warfarin
• unfractionated heparin
• plasma hemostasis