Clinical security with association of four antithrombotic drugs in the treatment of UA/NSTEMI: experience of our unit

Objective

To evaluate the clinical security of four antithrombotic drugs in association.

Methods

From April 2000 to December 2002 we followed 287 patients with acute coronary syndrome (UA/NSTEMI), and divided them in two groups: group I (90 patients), at least 20% older than 70 years, who used the association of enoxaparin + aspirin + clopidogrel + glycoprotein IIb/IIIa inhibitor; group II (remaining patients), who used enoxaparin + aspirin with or without clopidogrel.

We monitored the frequency of bleeding while in hospital and after 30 days as shown in TIMI (Ann Int Med 1991).

Results

There were no significant difference between the groups with regard to sex, risk factors, anti-ischemic drugs and the number of obstructed vessels or bleeding events in the 30 days following the beginning of the protocol. However, there were important differences with regard to the following: level of age, 57.4 ± 11 years for group I and 64.1 ± 13 years for group II (P < 0.001); troponin elevation, 88.9% in group I and 56.8% in group II (P < 0.001); ST–T wave abnormality, 41.2% in group I and 17.8% in group II (P < 0.001); and treatment with angioplasty or surgery, 91.1% for group I and 61.7% for group II (P < 0.0001).

Conclusions

In our experience, the association of four antithrombotic drugs was shown to be safe, and the association of tirofiban and enoxaparin did not lead to more bleeding events.