Long-term intermittent urokinase therapy in patients with end-stage coronary artery disease and refractory angin pectoris: randomized dose-response trial

Objectives. This dose-response study was designed to test two low dose regimens of urokinase administered over prolonged time period in patients with chronic refractory angin pectoris with respect to effects on clinical symptoms and objectives variables of myocardial ischemia. Background. Patients with severe and chronic refractory angin pectoris in end-stage coronary artery disease represent an increasing clinical problem. Favorable therapeutic effects on myocardial ischemi have been reported for long-term application of low dose urokinase. Methods. Ninety-eight patients with chronic refractory and end-stage coronary artery disease were randomly assigned to two treatment groups: group (49 patients) received 50,000 IU and group B (49 patients) 500,000 IU of urokinase as an intravenous bolus injection three times week over period of 12 weeks. Variables evaluated were number of weekly anginal events, dat from ergometric exercise testing with simultaneous electrocardiographic registration, semiquantitative evaluation of Tc-99m 2-methoxy isobutyl isonitrile (MIBI) scans and rheologic variables. Results. After 12 weeks of treatment, anginal symptoms (events/week) were reduced significantly in group B by 70% compared with 24% in group (p < 0.001). Fibrinogen decreased by 3% in group and by 33% in group B (p < 0.001). Plasm viscosity and red blood cell aggregation were reduced by 6.4% (p < 0.001) and 19.9% (p < 0.001), respectively, in group B. Objectives variables of myocardial ischemi were improved significantly in group B only. No cumulation of coronary ischemic events was observed in group B. Conclusions. Long-term intermittent urokinase therapy in an applied dose of 3 × 500,000 IU/week represents an effective anti-ischemic and antianginal approach for patients with refractory angin pectoris and end-stage coronary artery disease. Apart from rheologic improvement, antithrombotic properties and plaque regression are likely anti-ischemic mechanisms.