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Increasing the Stability of Unstable Angina

Joel Ray, MD
Arch Intern Med. 1997;157(2):246. doi:10.1001/archinte.1997.00440230126024.
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I enjoyed the update on thrombosis in ischemic heart disease by Ambrose and Weinrauch,1 especially because of their elucidation of the pathogenesis of the unstable coronary artery plaque and its relationship to arterial thrombosis.

I was surprised, however, when I read their discussion on the treatment of unstable angina. The authors rightly point out the proven efficacy of standard heparin therapy for unstable coronary artery syndrome. Unfortunately, they mention certain "future" agents that are being tested in clinical trials of unstable angina, such as hirudin, but fail to cite 2 recent randomized double-blinded trials in which low-molecular-weight heparins, which have already been proved to be effective, were used.2,3

The FRISC study group,2 for example, compared the combination of subcutaneous dalteparin and aspirin vs aspirin and placebo in the treatment of 1506 patients with unstable coronary artery disease. They observed significantly lower rates of death and myocardial infarction


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