RESUMO
PURPOSE: To evaluate the clinical efficacy and safety of subcutaneous (SC) low molecular weight heparin (LMWH) compared to intravenous (IV) non fractioned heparin (NFH) in unstable angina, acute myocardial infarction and post-percutaneous transluminal coronary angioplasty. METHODS: From September/92 to April/94, 314 patients were randomized in two groups. Group I-- 154 patients treated with SC LMWH, using in the 1st phase SC LMWH with a dosage of 160 UaXa IC/kg/day (group IA--92 patients), and in the 2nd, a dosage of 320 UaXa IC/kg/day (group IB--62 patients). Group II--160 patients treated with IV NFH 100UI/kg (bolus), followed by 1000UI/h with adjusted dosage by activated partial thromboplastin time. RESULTS: There was not a statistically significant difference among the three groups in relation to cardiac events, hemorrhagic complications and deaths. CONCLUSION: The clinical efficacy and safety of SC LMWH in patients with unstable angina, acute myocardial infarction and post-percutaneous transluminal coronary angioplasty were similar to IV NFH with the dosages used in this study.
Assuntos
Angina Instável/tratamento farmacológico , Angioplastia Coronária com Balão , Fibrinolíticos/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Angina Instável/complicações , Angina Instável/mortalidade , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Feminino , Heparina/uso terapêutico , Humanos , Infusões Intravenosas , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidadeRESUMO
PURPOSE: To describe the use of myocardial reperfusion strategies (percutaneous transluminal coronary angioplasty-PTCA and intravenous trombolysis) whenever it is possible to use emergency cinecoronariography in acute myocardial infarction (AMI). METHODS: The records of patients admitted with initial diagnosis of AMI, until six hours after the beginning of symptoms, were reviewed retrospectively, between March/92 and December/93. RESULTS: One hundred forty-three patients were admitted with suspected AMI. Eighty-one (57%) presented definitive criteria for this diagnosis. Fifty-two patients (64%) were admitted in the first six hours from the beginning of symptoms. Thirty-eight (73%) were male and the mean age was 59 +/- 12 years. Cinecoronariography was indicated immediately in 36 of 52 (69%) patients, with purpose to use PTCA. That was done in 30 (58%). Two (4%) patients were submitted to emergency surgical myocardial revascularization. Intravenous thrombolysis was used in 11 (21%) patients. At admission, the conservative treatment was chosen for five out of nine left patients, based on clinical grounds. CONCLUSION: The availability of emergency cinecoronariography made an early reperfusion strategy possible in 83% of patients admitted with AMI in the first six hours after the beginning of symptoms.