FRISC Trial Placebo control, double blind Lancet 347:561,1996 4.8% 4 Placebo (N=759) RR 0.37 (0.20-0.68) p = 0.001 Death / MI (%) 3 2 The recently reported FRISC Trial compared another low molecular weight heparin, dalteparin, that has a anti-Xa:anti-IIa of 2:1 with placebo in patients with unstable angina. There was a a 63% reduction in the sum of death or MI by day 6 in the patients who received twice daily, subcutaneous injections of dalteparin. This trial had a chronic therapy phase where patients originally receiving placebo during the acute phase continued to receive placebo injections while those receiving dalteparin in the acute phase received a reduced dose of dalteparin once daily in the chronic phase. The benefit of dalteparin seen in this slide during the acute phase was progressively lost during the chronic phase. This may have been due to inadequate anti-Xa activity because of only once daily injections with a low molecular weight heparin that has a low anti-Xa:anti-IIa ratio. Thus the possibility remains that twice daily injections with a drug such as enoxaparin may be effective during the chronic phase. 1.8% 1 Dalteparin (N=743) 1 2 3 4 5 6 7 Days