TY - JOUR
T1 - Promise of combined low-molecular-weight heparin and platelet glycoprotein IIb/IIIa inhibition
T2 - Results from platelet IIb/IIIa antagonist for the reduction of acute coronary syndrome events in a Global Organization Network B (PARAGON B)
AU - Mukherjee, Debabrata
AU - Mahaffey, Kenneth W.
AU - Moliterno, David J.
AU - Harrington, Robert A.
AU - Yadav, Jay S.
AU - Pieper, Karen S.
AU - Gallup, Dianne
AU - Dyke, Christopher
AU - Roe, Matthew T.
AU - Berdan, Lisa
AU - Lauer, Michael S.
AU - Mänttäri, Matti
AU - White, Harvey D.
AU - Califf, Robert M.
AU - Topol, Eric J.
N1 - Funding Information:
Supported by Hoffman-LA Roche Ltd.
PY - 2002/12/1
Y1 - 2002/12/1
N2 - Background: Low-molecular-weight heparin (LMWH) has a more predictable anticoagulant effect than unfractionated heparin (UFH), is easier to administer, and does not require monitoring. Minimal data are available on LMWH combined with platelet glycoprotein (GP) IIb/IIIa inhibitors. Methods: In the Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network B (PARAGON B) trial, patients with an acute coronary syndrome were randomized to receive the IIb/IIIa inhibitor lamifiban or a placebo. To rigorously explore the potential benefits of LWMH and GP IIb/IIIa inhibition, we analyzed the rates of ischemic complications and safely outcomes in PARAGON B. Results: Approximately one fifth of the patients received LMWH (805 vs 4395 UFH). For the overall cohort, the incidence of death/myocardial infarction (MI)/severe recurrent ischemia (SRI) was 12.2%, and this composite end point was numerically lowest in the lamifiban with LMWH group (10.2%). Similarly, the incidence of death/MI was 11.0% for the entire cohort and lowest in the lamifiban and LMWH group (9.0%). The lower event rate for patients taking LMWH in the lamifiban group was sustained at 6 months, with a lower revascularization rate (51.5% vs 42.8%) and a lower composite of death/MI (13.8% vs 11.9%). Bleeding was comparable in the 2 heparin groups (1.4% with UFH vs 0.9% with LMWH). The propensity adjusted odds ratio for 30-day revascularization was significantly lower with LMWH (odds ratio 0.67, 95% CI 0.57-0.79, P < .001). There were no significant differences in death/MI/SRI at 30 days (P = .465), death/MI at 30 days (P = .264), and stroke at 30 days with the type of heparin use (P = .201) after propensity risk adjustment. Conclusions: In the PARAGON B trial, use of LMWH in conjunction with a GP IIb/IIIa inhibitor was safe and associated with a lower revascularization rate. These findings support the rationale and promise for combining GP IIb/IIIa blockers and LMWH for future management of acute coronary syndrome.
AB - Background: Low-molecular-weight heparin (LMWH) has a more predictable anticoagulant effect than unfractionated heparin (UFH), is easier to administer, and does not require monitoring. Minimal data are available on LMWH combined with platelet glycoprotein (GP) IIb/IIIa inhibitors. Methods: In the Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network B (PARAGON B) trial, patients with an acute coronary syndrome were randomized to receive the IIb/IIIa inhibitor lamifiban or a placebo. To rigorously explore the potential benefits of LWMH and GP IIb/IIIa inhibition, we analyzed the rates of ischemic complications and safely outcomes in PARAGON B. Results: Approximately one fifth of the patients received LMWH (805 vs 4395 UFH). For the overall cohort, the incidence of death/myocardial infarction (MI)/severe recurrent ischemia (SRI) was 12.2%, and this composite end point was numerically lowest in the lamifiban with LMWH group (10.2%). Similarly, the incidence of death/MI was 11.0% for the entire cohort and lowest in the lamifiban and LMWH group (9.0%). The lower event rate for patients taking LMWH in the lamifiban group was sustained at 6 months, with a lower revascularization rate (51.5% vs 42.8%) and a lower composite of death/MI (13.8% vs 11.9%). Bleeding was comparable in the 2 heparin groups (1.4% with UFH vs 0.9% with LMWH). The propensity adjusted odds ratio for 30-day revascularization was significantly lower with LMWH (odds ratio 0.67, 95% CI 0.57-0.79, P < .001). There were no significant differences in death/MI/SRI at 30 days (P = .465), death/MI at 30 days (P = .264), and stroke at 30 days with the type of heparin use (P = .201) after propensity risk adjustment. Conclusions: In the PARAGON B trial, use of LMWH in conjunction with a GP IIb/IIIa inhibitor was safe and associated with a lower revascularization rate. These findings support the rationale and promise for combining GP IIb/IIIa blockers and LMWH for future management of acute coronary syndrome.
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U2 - 10.1067/mhj.2002.126118
DO - 10.1067/mhj.2002.126118
M3 - Article
C2 - 12486423
AN - SCOPUS:0036918874
VL - 144
SP - 995
EP - 1002
IS - 6
ER -