Heparin angina

A specific immunoassay for measuring two-chain factor VIIa levels in plasma has been developed to identify activation of factor VII in patients with acute coronary syndromes suchs as myocardial infarction and unstable angina (12). Because regulation of factor VIIa is believed to be mediated by tissue factor pathway inhibitor (TFPI), its measurement is also useful in assessing thombotic and cardio-vasular disorders. Because TFPI is released by heparin, its measurement is also useful in assessing the efficacy of heparin and endothelial cell function (93). 

Neri Semeri G. G., Gensini G. F., Poggessi L. Effect of heparin, aspirin oralteplase in reduction of myocardial ischaemia in refractory unstable angina. Lancet 1990 335,615-8. 

Bittl JA, Chaitman BR, Feit F, Kimball W, Topol EJ. (2001) Bivalirudin versus heparin during coronary angioplasty for unstable or postinfarction angina Final report reanalysis of the bivalirudin angioplasty study. Am Heart J142 952-959. 

Drug therapy of acute coronary syndromes including unstable angina and non-Q-wave myocardial infarction includes use of aspirin, heparin and anti-ischaemic drugs and is similar in older patients to other age groups. Activation of platelet thromboxane production in the coronary circulation has been demonstrated in unstable angina. The risk of myocardial infarction or death is reduced by approximately 50% by early aspirin therapy in recommended doses of 160-325 mg per day and continued... 

Tirofiban is a synthetic, nonpeptide inhibitor of glycoprotein-(GP)-receptors. Tirofiban has a rapid onset and short duration of action after intravenous administration. Coagulation parameters turn to normal 4-8 hours after the drug is withdrawn. Tirofiban in combination with heparin and aspirin is indicated in the management of patients with unstable angina or non-Q-wave myocardial infarction. 

Given to patients with a history of typical angina accompanied by either a past medical history of coronary artery disease or ECG/cardiac enzyme changes, low molecular weight heparins (LMWH) were more efficacious in reducing MI and revascularization, but not mortality, with fewer serious side-effects than unfractionated heparin (UFH) (see Magee et al., 2003). 

Holdright D, Patel D, Cunningham D, Thomas R, Hubbard W, Hendry G et al. Comparison of the effect of heparin and aspirin versus aspirin alone on transient myocardial ischemia and in-hospital prognosis in patients with unstable angina. J Am Coll Cardiol 1994 24(1) 39-45. 

In comparative studies of PTCA in unstable angina, incidence of major bleeding lower than heparin (4% vs 9%)... 

B. Indications and use Angiomax is indicated when given with aspirin for the prevention of ischemic complications in unstable angina patients during coronary angioplasty. It has been used successfully as a substitute for heparin. The efficacy of Angiomax appears to be similar to heparin with fewer bleeding complications. 

Heparin and antiplatelet drugs are therefore used in various forms of angina to help prevent infarction. When administered with the traditional anti-anginal medications, these anticoagulants can help decrease morbidity and mortality in people with ischemic heart disease. For more details on the effects of anticoagulant medications, please refer to Chapter 25. 

Abbreviations MI, myocardial infarction PCI, percutaneous coronary intervention PER primary end-point RA, refractory angina TLR, target lesion revascularization TVR, target vessel revascularization TNK, tenecteplase UFH, Unfractionated heparin UR, urgent reintervention. 

The PRISM Investigators. A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina. N Engl J Med 1998 338 1498-1505. 

The PAFfAGON Investigators. International, randomised, controlled trial of lamifiban (a platelet glycoprotein llb/llla inhibitor), heparin, or both in unstable angina. Circulation 1998 97 2386-395. 

I 5 van den Bos AA, Deckers JW, Heyndrickx GR, et al, Safety and efficacy of recombinant hirudin (CGP 39 393) versus heparin in patients with stable angina undergoing coronary angioplasty, Circulation 1993 88 2058-2066. 

Bittl JA, Strony J, Brinker JA, et al. Treatment with bivalirudin (hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. N Engl J Med 1995 333 764-769. 

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