RESUMEN
AIM: To study antianginal effectiveness of trimetazidine (TMS) in monotherapy and combined antianginal therapy; to design approaches to prediction of its effect. MATERIAL AND METHODS: An open cross-over randomised trial enrolled 29 anginal patients. They were given a single TMS dose (60 mg) and its effect was compared to that of placebo, propranolol, verapamil, isosorbide dinitrate, nifedipine). The effect was estimated by an increment of bicycle exercise (BE) duration necessary to depress ST segment by 1 mm. 10 patients retained signs of myocardial ischemia at BE though they were treated with specially selected antianginal drugs. In them, we assessed additional benefit of adjuvant TMS. The drugs were tried under acute test and one-month treatment. RESULTS: In acute test a significant antianginal effects of TMS were registered against the placebo. Differences in efficiency of the antianginal drugs were insignificant. The addition of TMS to the selected drugs gave rise to the trend to prolongation of time to ST segment depression by 1 mm. We found a strong correlation between TMS efficiency in acute pharmacological test and in long-term administration. This enables using BE for prediction of long-term effect of the drug. CONCLUSION: TMS has a significant antianginal effect. It is especially beneficial in cases of insufficient effectiveness of conventional antianginal drugs or when their use is problematic because of marked disturbances of hemodynamics.
Asunto(s)
Angina de Pecho/tratamiento farmacológico , Trimetazidina/administración & dosificación , Vasodilatadores/administración & dosificación , Administración Oral , Anciano , Anciano de 80 o más Años , Angina de Pecho/fisiopatología , Estudios Cruzados , Quimioterapia Combinada , Electrocardiografía/efectos de los fármacos , Prueba de Esfuerzo , Femenino , Humanos , Dinitrato de Isosorbide/administración & dosificación , Masculino , Persona de Mediana Edad , Nifedipino/administración & dosificación , Pronóstico , Propranolol/administración & dosificación , Verapamilo/administración & dosificaciónRESUMEN
The oral use of the drug Piavit (derived from freeze-dried medicinal leeches) in 50 patients with coronary heart disease for 7 days in a daily dose of 600 mg (20 patients) and 1200 mg (30 patients) caused a moderate dose-independent increase in enzymatic, fibrinolysis, non-enzymatic fibrinolysis and antithrombin III activity. In half the patients who had low fibrinolytic levels, the agent stimulated mainly the release of plasminogen activator on administration days of 2 and 7. In other 15 patients the activity of plasminogen activator remained unchanged, but non-enzymatic fibrinolysis enhanced. Piavit prolonged the hypocoagulative effect of heparin and aspirin in the group of patients pretreated with these drugs. There were no clinical manifestations of the disease during 7 days.