Background: Antithrombotic therapy with heparin reduces the rate of ischemic events in patients with acute coronary syndrome. Low-molecular-weight heparin, given subcutaneously twice daily, has a more predictable anticoagulant effect than standard unfractionated heparin. Moreover, it is easier to administer and does not require monitoring.
Methods: We prospectively analyzed 180 patients with unstable angina who had undergone percutaneous coronary intervention (PCI) between 1999 and 2001 at Chonnam National University Hospital and had received either 120 U/kg of dalteparin (Fragmin), administered subcutaneously twice daily (Group I; n = 90, 61.8 +/- 8.9 years, male 67.8%), or had received continuous intravenous unfractionated heparin (Group II; n = 90, 62.6 +/- 9.7 years, male 70.0%). During hospitalization and at 6 month after PCI, major adverse cardiac events such as acute myocardial infarction, target vessel revascularization, death, and restenosis were examined.
Results: During hospitalization, the incidence of acute myocardial infarction, target vessel revascularization and death were not different between the two groups. At follow-up coronary angiography 6 months after PCI, the incidence of restenosis was lower in group I than in group II (Group I; 26/90, 28.8% vs. Group II; 32/90, 35.6%, p = 0.041) and the incidence of target vessel revascularization was lower in group I than in group II (Group I; 21/90, 23.3% vs. Group II; 27/90, 30.0%, p = 0.039). No difference was found in the rates of major and minor hemorrhages, ischemic strokes or thrombocytopenia between two groups. By multivariate analysis, the factors related to restenosis were lesion length, postprocedural minimal luminal diameter, CRP on admission, diabetes mellitus, the type of heparin, and stent use.
Conclusion: Dalteparin, a low molecular weight heparin, is superior to standard unfractionated heparin in terms of reducing the restenosis rate and target vessel revascularization without increasing bleeding complications.