Randomized evaluation of the efficacy of enoxaparin versus unfractionated heparin in high-risk patients with non–ST-segment elevation acute coronary syndromes receiving the glycoprotein IIb/IIIa inhibitor eptifibatide. Long-term results of the Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment (INTERACT) trial - 17/08/11
, Anatoly Langer, MD, MSc a, b, Paul W. Armstrong, MD c, Mary Tan, BSc a, Aurora Mendelsohn, PhD a, Shaun G. Goodman, MD, MSc a, bfor the INTERACT Trial Long-Term Follow-Up Investigatorsd
Résumé |
Background |
Patients with high-risk non–ST-segment elevation acute coronary syndromes (NSTE ACS) benefit from the early administration of aspirin, a small molecule glycoprotein IIb/IIIa inhibitor such as eptifibatide, and heparin. The INTERACT trial demonstrated that in high-risk patients with ACS receiving aspirin and eptifibatide, the use of enoxaparin compared with unfractionated heparin (UFH) was associated with less bleeding, less early myocardial ischemia, and improved 30-day outcomes.
Objective |
The aim of our study was to determine whether the short-term benefits of enoxaparin compared with UFH observed in high-risk patients with NSTE ACS are maintained over a prolonged period of follow-up.
Methods |
Six hundred thirty-nine patients that were representative of the total population of subjects in the INTERACT trial were followed up for a median period of 2.5 years.
Results |
In this group, the early benefit of enoxaparin was maintained. The incidence of death or myocardial infarction at the time of long-term follow-up was 39% lower in patients receiving enoxaparin compared with those who received UFH (8.9% vs 14.7%, P = .024). There was no difference in the frequency of cardiac catheterization in the groups receiving either enoxaparin or UFH.
Conclusions |
The early treatment of high-risk patients with NSTE ACS receiving aspirin and eptifibatide with enoxaparin is associated with early outcome benefits that are sustained over a prolonged follow-up period. This trial supports the concept that early treatment directed against platelet and thrombin formation is associated with better short- and long-term outcomes.
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| Conflicts of interest: Drs Fitchett, Langer, Armstrong, and Goodman have received research grant support, speaker honoraria, or consultant fees from Aventis Canada, Key Pharmaceuticals, Division of Schering Canada Inc, and Millenium Pharmaceuticals. |
Vol 151 - N° 2
P. 373-379 - février 2006 Retour au numéro
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