Please use this identifier to cite or link to this item: http://hdl.handle.net/11054/262
Title: Design, baseline characteristics, and preliminary clinical results of the organization to assess strategies for ischemic syndromes-2 (OASIS-2) trial.
Authors: Yusuf, Salim
Issue Date: 1999
Publisher: Elsevier
Place of publication: Dallas, TX.
Journal title: The American Journal of Cardiology
Volume: 84
Issue: 5A
Start Page: 20M
End Page: 25M
Abstract: Despite use of heparin and aspirin, 5–10% of patients with unstable angina develop myocardial infarction (MI) or refractory angina in the hospital. We tested the hypothesis that recombinant hirudin (lepirudin), a direct thrombin inhibitor, is superior to heparin, an indirect thrombin inhibitor, in patients with acute ischemic syndromes who were receiving aspirin. Patients (n = 10,141) with unstable angina or suspected acute MI without ST-segment elevation were randomly assigned heparin (5,000-U bolus, then 15-U/kg per hour infusion; n = 5,058) or hirudin (0.4-mg/kg bolus, then 0.15-mg/kg per hour infusion; n = 5,083) for 72 hours in a double-blind trial. The primary outcome measure was cardiovascular death or new MI at 7 days. Analysis was by intention to treat. At 7 days, 213 patients (4.2%) in the heparin group and 182 (3.6%) in the hirudin group had experienced cardiovascular death or new MI (relative risk = 0.84; 95% CI = 0.69–1.02; p = 0.077). The number of patients with cardiovascular death, new MI, or refractory angina at 7 days was 340 (6.7%) with heparin and 284 (5.6%) with hirudin (relative risk = 0.82; 95% CI = 0.70–0.96; p = 0.0125). These differences were primarily observed during the 72-hour treatment period (cardiovascular death or MI relative risk = 0.76; 95% CI = 0.59–0.99; p = 0.039; cardiovascular death, MI, or refractory angina relative risk = 0.78; 95% CI = 0.63–0.96; p = 0.019). Although there was an excess of major bleeding with hirudin requiring transfusion (59 [1.2%] vs 34 [0.7%] with heparin; p = 0.01), there was no excess in life-threatening episodes (20 in each group) or strokes (14 in each group). Data from the Organization to Assess Strategies for Ischemic Syndromes (OASIS)-2 trial suggest that a direct thrombin inhibitor, recombinant hirudin, is more effective than an indirect thrombin inhibitor, heparin, in preventing cardiovascular death, MI, or refractory angina. Recombinant hirudin also has an acceptable safety profile in patients with unstable angina or acute MI without ST-segment elevation. This trial was undertaken with the assistance of the Ballarat Base Hospital: J. Strickland; C. Tauschke; L. Taylor.
URI: http://hdl.handle.net/11054/262
metadata.dc.relation.uri: http://www.sciencedirect.com/science/article/pii/S0002914999005494
ISSN: 0002-9149
Internal ID Number: 00265
Health Subject: RANDOMISED CONTROLLED TRIAL
ANGINA
MYOCARDIAL INFARCTION
ASPRIN
THROMBIN INHIBITOR
Type: Journal Article
Article
Appears in Collections:Research Output

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.