Circulation, Vol 89, 81-88, Copyright © 1994 by American Heart Association
M Cohen, PC Adams, G Parry, J Xiong, D Chamberlain, I Wieczorek, KA Fox, JH Chesebro, J Strain and C Keller
BACKGROUND: The purpose of this study was to compare combination
antithrombotic therapy with aspirin plus anticoagulation versus aspirin
alone, when added to conventional antianginal therapy in patients with
unstable rest angina or non-Q-wave myocardial infarction who were nonprior
aspirin users. METHODS AND RESULTS: Two hundred fourteen patients were
randomized; 109 were randomized to receive aspirin alone (162.5 mg daily)
and 105 to receive a combination of aspirin plus anticoagulation, ie,
aspirin 162.5 mg daily plus heparin (activated partial thromboplastin time,
two times control) followed by aspirin 162.5 mg daily plus warfarin
(international normalized ratio, 2 to 3). Trial therapy was begun by 9.5
+/- 8.8 hours of qualifying pain and was continued for 12 weeks. Primary
end points were recurrent angina with ECG changes, myocardial infarction,
and/or death. Analysis by intention to treat of primary events at 12 weeks
was performed. At 14 days, there was a significant reduction in total
ischemic events in the combination group versus aspirin alone (10.5% versus
27%, P = .004). An efficacy analysis of primary events at 12 weeks also
revealed a large reduction in total ischemic events in the combination
group versus aspirin alone (13% versus 25%, P = .06). Bleeding
complications were slightly more common with combination therapy.
CONCLUSIONS: In nonprior aspirin users, combination antithrombotic therapy
with aspirin plus anticoagulation significantly reduces recurrent ischemic
events in the early phase of unstable angina.
ARTICLES
Combination antithrombotic therapy in unstable rest angina and non-Q- wave infarction in nonprior aspirin users. Primary end points analysis from the ATACS trial. Antithrombotic Therapy in Acute Coronary Syndromes Research Group
Likoff Cardiovascular Institute, Hahnemann University Hospital, Philadelphia, Pa. 19102-1192.
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