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Novel Therapy Developed For Particular Coronary Syndrome

Using aspirin and eptifibatide in patients with high-risk non-ST-segment elevation acute coronary syndromes, allows enoxaparin to improve outcomes, say Canadian researchers.

The therapy was tested for safety and efficacy in the Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment (INTERACT) Trial by investigators at the Canadian Heart Research Centre and Terrence Donnelly Heart Centre, University of Toronto.

The clinicians note that therapeutic options in treatment among high-risk non-ST-segment elevation acute coronary syndrome patients include aspirin, clopidogrel, heparin, and platelet glycoprotein IIb/IIIa inhibition. However, there is major uncertainty among clinicians about how safe, and effective, is a combined dose of glycoprotein IIb/IIIa inhibitor and low-molecular-weight heparin.

The INTERACT trial enrolled 746 patients with rest ischaemic discomfort within 24 hours after the onset of symptoms, and ST-segment deviation and/or elevation of serum cardiac markers. They were randomised to receive either open-label enoxaparin, twice daily or unfractionated heparin for 48 hours. In addition, patients in both groups received aspirin and eptifibatide.

The researchers found that major non-coronary artery bypass surgery-related bleeding at 96 hours, the primary safety outcome, was significantly lower among those who received enoxaparin (1.8%) than among those who received heparin (4.6%). Minor bleeding was more frequent among patients who received enoxaparin (30.3%) than among those who revived heparin (20.8%).

Patients who received enoxaparin were less likely to experience ischaemia, as detected by continuous electrocardiogram evaluation during the initial, and subsequent, 48-hour monitoring periods. Death or myocardial infarction at 30 days was significantly lower among the patients who received enoxaparin (5%) compared with those who received heparin (9%).

The clinicians conclude: "When aspirin and eptifibatide are used in high-risk non-ST-segment elevation acute coronary syndrome patients, enoxaparin improves outcomes (determined on the basis of better safety and efficacy) compared with currently recommended unfractionated heparin therapy and provides a useful novel alternative therapeutic strategy."
Circulation 2003;107:2:238-44. "Randomized evaluation of the safety and 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."

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