מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – While prior aspirin users who are admitted with coronary syndromes may have a less severe clinical presentation, they are more likely to have a poor response with unfractionated heparin. For these patients, enoxaparin or the combination of tirofiban and unfractionated heparin are more effective than unfractionated heparin alone.
Dr. Gilead I. Lancaster and colleagues from Danbury Hospital in Connecticut examined the response to medical therapy in patients who were taking aspirin before being admitted with an acute coronary syndrome. Dr. Lancaster's group reviewed outcome data from the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) and Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) studies.
"Patients with acute coronary syndromes who had taken aspirin prior to enrollment were less likely to have non-Q-wave myocardial infarction on admission (ESSENCE: 16.0% versus 29.2%, p < 0.001; PRISM-PLUS: 34.2% versus 57.7%, p < 0.001)," the investigators report in the September/October issue of the International Journal of Cardiology.
However, they note that in both studies, patients who used aspirin prior to admission were more likely to failed standard medical therapy with unfractionated heparin than were patients who did not use aspirin before admission (ESSENCE: 21.5% versus 16.5%, p = 0.017); PRISM-PLUS: 23.5% versus 12.1%, p < 0.001).
"Prior aspirin users received greater benefit from both enoxaparin (21.5% versus 16.8%, p = 0.009) and tirofiban with unfractionated heparin (23.5% versus 16.%, p = 0.007) than from unfractionated heparin alone," the researchers explain. Patients who did not use aspirin prior to admission presented with higher rates of non-Q-wave myocardial infarction.
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