课件：acs的抗血小板.ppt

* 2.2.3 The FRIC study Thetrial randomized 1581 unstable angina/non-Q-wave MI patients to receive 75 mg once daily of aspirin and in an open-label manner either dalteparin 120 IU/kg/12h SC or unfractionated heparin as a 5000 IU bolus followed by 1000 IU/h infusion for at least 48h and then 12,500 IU/12 SC for days 1-6. A second randomization then assigned patients in a double-blind manner to prolonged treatment through day 40 with either dalteparin 7500 IU/24 SC or placebo. Data on the open-label phase only (through day 6) are available and demonstrated no difference between dalteparin and unfractionated heparin. The incidence of the composite endpoint of death, MI and angina requiring revascularization was 13% in the dalteparin group and 12.5% with unfractionated heparin (risk reduction 1.05, 95 percent CI 0.80-1.37, p=0.99). For death plus MI, the incidence was 3.9 percent with dalteparin versus 3.6 with heparin. * * * * * 36 * * * * * * During the acute phase, all eligible patients were treated with aspirin and were then randomized to double-blind treatment either with UFH for a minimum of 3 days beginning with a bolus of 70 units/kg and an initial infusion of 15 units/kg/hour to target aPTT of 1.5-2.5 x control (coordinated through an unblinded third party) or enoxaparin given as an intravenous bolus of 30 mg followed by subcutaneous injections of 1 mg/kg every 12 hrs. The primary efficacy endpoint was a composite of all cause mortality, recurrent myocardial infarction based on standard ECG and serum marker criteria, and urgent revascularization defined as an episode of recurrent angina prompting revascularization on the index hospitalization or on readmission.  The primary safety endpoint was major bleeding resulting either in death, a bleed in a retroperitoneal, intracranial, or intraocular location, a hemoglobin drop of at least 3 grams/decliter or the requirement of transfusion of at least 2 units of blood.  Double-blind treatment du