FRISC Trial Casts Light On Antithrombotic Use

3 September 1995

Fragmin (dalteparin sodium), the low molecular weight heparin marketed by Pharmacia, has become the first drug of its type to show additional benefit on top of standard therapy including aspirin in the prevention of cardiac events in patients with unstable angina or non-Q wave myocardial infarction. This population of patients represents around 40% of those admitted to coronary care units. The study was presented at the European Society of Cardiology meeting in Amsterdam on August 24.

The role of aspirin in the treatment of these acute coronary syndromes is now well established, but the role of unfractionated heparin is less defined. Aspirin has transformed the treatment of these patients, but its use is still associated with a high rate of cardiac events, which has led many doctors to adopt a relatively untested six-day, intravenous unfractionated heparin infusion in an attempt to improve outcome. This regimen requires a cumbersome infusion protocol, which generally means that it is used only in selected patients. It is also often terminated early, before the recommended time.

FRISC investigated whether Fragmin could overcome some of the limitations of heparin, as well as providing key data on the usefulness of more aggressive antithrombotic therapy. LMWH has been widely used in the management of patients with deep vein thrombosis for 10 years. Its advantages are that it can be given by once-daily subcutaneous injection rather than an infusion, and patient monitoring and dose titration is not required. In addition, Fragmin has been associated with fewer bleeding episodes than unfractionated heparin.

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