Abstract | BACKGROUND: METHODS: At 373 hospitals in 13 countries, 12,142 patients with acute coronary syndromes were randomly assigned to 72 hours of therapy with either intravenous heparin or hirudin. Patients were stratified according to the presence of ST-segment elevation on the base-line electrocardiogram (4131 patients) or its absence (8011 patients), with the latter characteristic considered to indicate unstable angina or non-Q-wave myocardial infarction. RESULTS: At 24 hours, the risk of death or myocardial infarction was significantly lower in the group assigned to hirudin therapy than in the group assigned to heparin (1.3 percent vs. 2.1 percent, P = 0.001). The primary end point of death or nonfatal myocardial infarction or reinfarction at 30 days was reached in 9.8 percent of the heparin group as compared with 8.9 percent of the hirudin group (odds ratio for the risk of the end point in hirudin group,0.89; 95 percent confidence interval, 0.79 to 1.00; P = 0.06). The predominant effect of hirudin was on myocardial infarction or reinfarction and was not influenced by ST-segment status. There were no significant differences in the incidence of serious or life-threatening bleeding complications, but hirudin therapy was associated with a higher incidence of moderate bleeding (8.8 percent vs. 7.7 percent, P = 0.03). CONCLUSIONS:
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Authors | Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb investigators |
Journal | The New England journal of medicine
(N Engl J Med)
Vol. 335
Issue 11
Pg. 775-82
(09 12 1996)
ISSN: 0028-4793 [Print] United States |
PMID | 8778585
(Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antithrombins
- Fibrinolytic Agents
- Recombinant Proteins
- Heparin
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Topics |
- Aged
- Angina, Unstable
(drug therapy, mortality)
- Antithrombins
(therapeutic use)
- Double-Blind Method
- Female
- Fibrinolytic Agents
(therapeutic use)
- Heparin
(therapeutic use)
- Hirudin Therapy
- Humans
- Incidence
- Male
- Middle Aged
- Myocardial Infarction
(drug therapy, epidemiology, mortality)
- Partial Thromboplastin Time
- Recombinant Proteins
(therapeutic use)
- Recurrence
- Survival Analysis
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