A method of treating acute coronary syndrome without st segment elevation

 

(57) Abstract:

The invention relates to medicine, specifically to cardiology, and relates to methods of treatment of acute coronary syndrome without ST segment elevation. For this treatment provide by assigning enoksaparina dose of 1 mg/kg twice daily subcutaneously for 5-8 days in combination with aspirin at a dose of 250 mg/day and an additional assignment from the third to fifth day of treatment enoksaparina fenilina at a dose of 60 mg/day for 2 days, then at a dose of 45 mg/day for 2 days. From the fourth day of treatment venelina every 3 days to determine MANY indicator prothrombin time. When the value INR greater than 3.0 dose fenilina reduced to 15 mg/day, when the MPE value less than 2.0 dose fenilina increased to 15 mg/day. After the selection of the optimum therapeutic dose of Fineline control MPE carry out 1 time per month, the course of treatment is 12-36 months. The method provides prevention hypercoagulable without increasing the frequency of hemorrhagic complications.

The invention relates to medicine, specifically to cardiology, and relates to methods of treatment of acute coronary syndrome without ST segment elevation.

Currently, as in the molecular heparins.

The closest (prototype) is a method of treating acute coronary syndrome without ST-segment elevation by assigning enoksaparina in combination with aspirin. Enoxaparin is administered in a dose of 1 mg/kg of patient's weight subcutaneously twice a day for eight days. Aspirin prescribed at a dose of 250 mg/day.

However, after stopping the introduction of enoksaparina possible activation of the blood coagulation system that leads to relapse of acute coronary heart disease; adverse coronary events (recurrence of angina, krupnooptovye myocardial infarction, death) occur in 16% of patients within 1 month of observation (Cohen M. et al., 1997).

The problem solved by this invention is to prevent hypercoagulation, lowering the frequency of occurrence of adverse coronary events, increasing the effectiveness of treatment.

The problem is solved by a method for the treatment of acute coronary syndrome without ST-segment elevation by assigning enoksaparina dose of 1 mg/kg twice daily subcutaneously for 5-8 days in combination with aspirin at a dose of 250 mg/day and an additional assignment from the third to fifth day of treatment enoksaparina fenilina at a dose of 60 mg/day for 2 days, then ormalization ratio (MPE) and the MPE value greater than 3.0 dose fenilina reduced to 15 mg/day, when the MPE value less than 2.0 dose fenilina increased to 15 mg/day; after the selection of the optimum therapeutic dose of Fineline control MPE carry out 1 time per month, the course of treatment is 12-36 months.

New in the proposed method is that advanced from the third to fifth day of treatment enoksaparina appoint Venelin at a dose of 60 mg/day for 2 days, then at a dose of 45 mg/day for 2 days. From the fourth day of treatment venelina every 3 days to determine MPE and MPE value greater than 3.0 dose fenilina reduced to 15 mg/day, when the MPE value less than 2.0 dose fenilina increased to 15 mg/day; after the selection of the optimum therapeutic dose of Fineline control MPE carry out 1 time per month, the course of treatment is 12-36 months.

Not found in literature studies on the effectiveness of Fineline in complex antithrombotic therapy in patients with ACS without ST-segment elevation within 12-36 months of treatment.

This set of distinctive features is not known from the prior art and are not explicitly derived for the average specialist.

The proposed method was tested in the emergency Department of cardiology, Institute of cardiology, Tomsk scientific.

Thus, th is Animoā€¯.

To improve the effectiveness of treatment enoksaparina, lowering the risk of adverse coronary events, prevention of hypercoagulation, which develops in some patients after discontinuation enoksaparina, a method of treatment venelina in complex antithrombotic therapy.

The method is as follows. The patient simultaneously enoxaparin at a dose of 1 mg/kg of body weight twice a day subcutaneously for 5-8 days and aspirin daily dose of 250 mg/day once a day; the third and fifth day of treatment enoksaparina additionally given Venelin at a dose of 60 mg/day for 2 days, then at a dose of 45 mg/day for 2 days. From the fourth day of treatment venelina every 3 days to determine MPE. From the cubital vein of the patient blood sample in silikonizirovannaya tube containing 3.8% solution of sodium citrate; the ratio of the volumes of blood and sodium citrate to 9:1. After centrifugation (at 3000 rpm) for 15 min obtain platelet-poor plasma, then determine the prothrombin time (PT) in the plasma samples of the patient and control plasma and count prothrombin ratio (ON) by the formula:

ON=(PV patient)/(PV control plasma).

Then apreder CLASS="ptx2">

INR=MICHIGAN.

At therapeutic level MPE in the range of 2.0 to 3.0 is a good balance of prevention hypercoagulation and risk of bleeding. When the MPE value greater than 3.0 dose fenilina reduced to 15 mg/day, when the MPE value less than 2.0 dose fenilina increased to 15 mg/day; thus, the dose is adjusted individually and regulate largest MPE (2.0 to 3.0). After the selection of the optimum therapeutic dose of Fineline control MPE carry out 1 time per month. Treatment the optimal dose of Fineline (MPE 2.0 to 3.0) in combination with aspirin at a dose of 125 mg/day equal 12-36 months.

Example. Patient S., weighing 80 kg, was admitted to the emergency Department of cardiology diagnosed with acute re small posterolateral myocardial infarction. Assigned to enoxaparin for eight days at a dose of 80 mg 2 times a day subcutaneously in combination with aspirin at a dose of 250 mg/day. The fifth day of therapy added phenylin - 60 mg/day. From the seventh day dose fenilina reduced to 45 mg/day. On the eighth day of MPE is 3.5. From the ninth day dose fenilina reduced to 30 mg/day. On the tenth day of the MPE is equal to 2.5 and dose fenilina left the same: 30 mg/day. Then within 12 months of patient C. received Venelin; monthly provoders the month MPE is equal to 1.9, dose fenilina - 45 mg/day, 3 month MPE equal to 2.3, the dose of Fineline - 45 mg/day, 4 months MPE is equal to 2.2, the dose of Fineline - 45 mg/day, 5 month MPE equal to 2.5, the dose of Fineline - 45 mg/day, 6 month MPE is equal to 2.2, the dose of Fineline - 45 mg/day, 6 month MPE is equal to 2.4, the dose of Fineline - 45 mg/day, 7 month MPE equal to 2.3, the dose of Fineline - 45 mg/day, 8 month MPE is equal to 2.9, dose fenilina - 45 mg/day, 9 month MPE is equal to 3.2, the dose of Fineline - 30 mg/day, 10 month MPE is equal to 2.9, dose fenilina - 30 mg/day, 11 month MPE equal to 2.5, the dose of Fineline - 30 mg/day, 12 month MPE equal to 2.3, the dose of Fineline - 30 mg/day. During the observation time within 12 months adverse coronary event in a patient with C. were observed.

The appointment of Fineline us was chosen experimentally and clinically. As has been shown in clinical trials to 120 patients, this mode is optimal for achieving the objectives.

We compared the effectiveness of treatment of 120 patients with acute coronary syndrome without ST-segment elevation: the first group (n=60) received enoxaparin and aspirin; the second group (n=60) - enoxaparin, aspirin and Venelin above described method of treatment. The incidence of serious coronary events to a 30 day follow-up patients of the first group amounted to 26.6% in patients storvreta as patients of the second group - 11% (p<0,05). A significant decrease in the frequency of adverse coronary events in the group treated with long-term Venelin that is explained by the fact that Venelin prevented development of hypercoagulation after cancellation enoksaparina. Adding venelina to aspirin had an advantage over monotherapy with aspirin in patients undergoing coronary syndrome, without a statistically significant increased incidence of serious bleeding complications.

Thus, we have developed a method of treating venelina in complex antithrombotic therapy in acute coronary syndrome without ST-segment elevation allowed to reach a new positive results: lowering the risk of acute thrombosis of the coronary arteries and the development of adverse coronary events without increasing the frequency of hemorrhagic complications.

Literature

1. Cohen M, Demers C, Gurfinkel EP, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. N Engl. J. Med. 1997; 337: 447-52.

A method of treating acute coronary syndrome without ST segment elevation, which is to assign enoksaparina dose of 1 mg/kg twice daily subcutaneously for 5-8 days in combination with the prescribed Venelin at a dose of 60 mg/day for 2 days then at a dose of 45 mg/day within 2 days from the fourth day of treatment venelina every 3 days, determine the INR rate of prothrombin time and when the value of MPE more than 3.0 dose fenilina reduced to 15 mg/day, when the MPE value less than 2.0 dose fenilina increased to 15 mg/day; after the selection of the optimum therapeutic dose of Fineline control MPE carry out 1 time per month, the course of treatment is 12-36 months.

 

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