ASPIRIN VERSUS HEPARIN TO PREVENT MYOCARDIAL-INFARCTION DURING THE ACUTE-PHASE OF UNSTABLE ANGINA

Background. Antiplatelet therapy with aspirin and antithrombotic therapy with heparin both prevent the complications of unstable angina; however, no definitive data exist on the relative clinical efficacy of the two drugs. Methods and Results. Aspirin (325 mg bid) or heparin (5000-U intravenous bolus followed by a perfusion titrated to the APTT) were compared in a double-blind randomized trial of 484 patients in two cohorts enrolled sequentially. The study was initiated at admission to hospital at a mean of 8.3+/-7.8 hours after the last episode of pain. End points were assessed 5.7+/-3.3 days later, when the decision for long-term management was made. Myocardial infarction occurred in 2 (0.8%) of the 240 patients randomized to heparin and in 9 (3.7%) of the 244 randomized to aspirin (P=.035), an odds ratio of 0.22 and a risk difference of 2.9% (95% confidence limits, 0.3% to 5.6%) with heparin. The only death resulted from a myocardial infarction in an aspirin patient. Survival curves with Cox logistic regression analysis showed that the improvement in survival without myocardial infarction with heparin (P=.035) was independent of other baseline characteristics. Conclusions. This study documents that heparin prevents myocardial infarction better than aspirin during the acute phase of unstable angina.