Benefit ofAddingLowMolecular Weight Heparin totheConventional Treatment of Stable AnginaPectoris A Double-Blind, Randomized, Placebo-Controlled Trial

Background. Patients withchronic coronaryartery disease exhibit adysfunctioning endothelium, which may beresponsible forexercise-induced platelet activation andexpression ofa procoagulant moiety. In thisstudy, we evaluated thetherapeutic efficacy ofa lowmolecular weight heparin (Parnaparin) in patients withstable angina pectoris. Methods andResults. According toadouble-blind, randomized, placebo-controlled trial, 29patients with stable exercise-induced angina pectoris andangiographically provencoronaryartery disease received a single daily subcutaneous injection ofParnaparin or placebo on topofaspirin andconventional antianginal medication over3months. Patients randomized toParnaparin showed a significant decrease inthefibrinogen level (P=.035) andan improvement inboththetimeto1-mmSTsegmentdepression (P=.008) andthepeakSTsegment depression (P=.015). TheCanadian Cardiovascular Society class for anginapectoris was alsoimproved byParnaparin (P=.016). Parnaparin didnotaffect ADP and collagen-induced platelet aggregation, whereas thrombin-induced aggregation was reduced (P=.0001). Thebleeding timewas slightly prolonged, butthis was notassociated withanysignificant bleeding. Conclsions. Patients withstable angina pectoris may betreated withParnaparin inaddition toaspirin andconventional antianginal medication. Sideeffects are negligible, andcompliance isexcellent. (Circulation. 1993;88:2517-2523.)