Recombinant tissue-type plasminogen activator followed by heparin compared with heparin alone for refractory unstable angina pectoris

Diego Ardissino, Paolo Barberis, Stefano De Servi, Antonio Mussini, Alberto Rolla, Luigi Visani, Giuseppe Specchia

Research output: Contribution to journalArticlepeer-review

Abstract

Patients with unstable angina pectoris who remain symptomatic despite medical treatment are at high risk of death and myocardial infarction. The incidence of refractory unstable angina was examined in a consecutive series of 103 patients who received conventional medical treatment with nitrates, β blockers, calcium antagonists and aspirin. During 48 hours of continuous electrocardiographic monitoring, 24 patients had ≥1 anginal attack, 5 of whom had both painful and painless ischemic episodes. In these 24 patients with unstable angina refractory to conventional medical treatment, the short-term efficacy of recombinant tissue-type plasminogen activator (rt-PA) followed by heparin was assessed and compared with heparin alone in a randomized double-blind trial. Recurrences of ischemic attacks during a 72-hour follow-up period were documented in 9 of the 12 patients given heparin alone. All patients experienced at least 1 symptomatic ischemic episode and 1 patient had both painful and painless ischemia. No patient given rt-PA plus heparin had either symptomatic or asymptomatic ischemic attacks during follow-up. Kaplan-Meier curves analysis demonstrated a significantly higher probability of being ischemia free in the group of patients treated with rt-PA followed by heparin than in the group treated with heparin alone (p <0.01). Quantitative coronary arteriography failed to reveal any significant changes of ischemia-related lesions before and after each treatment. This study demonstrates that the combination of rt-PA and heparin has a greater protective effect than heparin alone in treating recurrent ischemic episodes in patients with refractory unstable angina. The clinical benefit of thrombolysis is not persistent and it does not eliminate the need for revascularization but may allow the procedures to be performed under more stable clinical conditions.

Original languageEnglish
Pages (from-to)910-914
Number of pages5
JournalThe American Journal of Cardiology
Volume66
Issue number12
DOIs
Publication statusPublished - Oct 15 1990

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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