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Promise of combined low-molecular-weight heparin and platelet glycoprotein IIb/IIIa inhibition: results from Platelet IIb/IIIa Antagonist for the Reduction of Acute coronary syndrome events in a Global Organization Network B (PARAGON B).
Am Heart J. 2002 Dec; 144(6):995-1002.AH

Abstract

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 safety 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.

Authors+Show Affiliations

University of Michigan Health System, Ann Arbor, Mich, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12486423

Citation

Mukherjee, Debabrata, et al. "Promise of Combined Low-molecular-weight Heparin and Platelet Glycoprotein IIb/IIIa Inhibition: Results From Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network B (PARAGON B)." American Heart Journal, vol. 144, no. 6, 2002, pp. 995-1002.
Mukherjee D, Mahaffey KW, Moliterno DJ, et al. Promise of combined low-molecular-weight heparin and platelet glycoprotein IIb/IIIa inhibition: results from Platelet IIb/IIIa Antagonist for the Reduction of Acute coronary syndrome events in a Global Organization Network B (PARAGON B). Am Heart J. 2002;144(6):995-1002.
Mukherjee, D., Mahaffey, K. W., Moliterno, D. J., Harrington, R. A., Yadav, J. S., Pieper, K. S., Gallup, D., Dyke, C., Roe, M. T., Berdan, L., Lauer, M. S., Mänttäri, M., White, H. D., Califf, R. M., & Topol, E. J. (2002). Promise of combined low-molecular-weight heparin and platelet glycoprotein IIb/IIIa inhibition: results from Platelet IIb/IIIa Antagonist for the Reduction of Acute coronary syndrome events in a Global Organization Network B (PARAGON B). American Heart Journal, 144(6), 995-1002.
Mukherjee D, et al. Promise of Combined Low-molecular-weight Heparin and Platelet Glycoprotein IIb/IIIa Inhibition: Results From Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network B (PARAGON B). Am Heart J. 2002;144(6):995-1002. PubMed PMID: 12486423.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Promise of combined low-molecular-weight heparin and platelet glycoprotein IIb/IIIa inhibition: 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, PY - 2002/12/18/pubmed PY - 2003/1/17/medline PY - 2002/12/18/entrez SP - 995 EP - 1002 JF - American heart journal JO - Am Heart J VL - 144 IS - 6 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 safety 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/12486423/Promise_of_combined_low_molecular_weight_heparin_and_platelet_glycoprotein_IIb/IIIa_inhibition:_results_from_Platelet_IIb/IIIa_Antagonist_for_the_Reduction_of_Acute_coronary_syndrome_events_in_a_Global_Organization_Network_B__PARAGON_B__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870302002235 DB - PRIME DP - Unbound Medicine ER -