PMID- 12486423
OWN - NLM
STAT- MEDLINE
DCOM- 20030116
LR  - 20131121
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 144
IP  - 6
DP  - 2002 Dec
TI  - 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).
PG  - 995-1002
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 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.
FAU - Mukherjee, Debabrata
AU  - Mukherjee D
AD  - University of Michigan Health System, Ann Arbor, Mich, USA.
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
FAU - Moliterno, David J
AU  - Moliterno DJ
FAU - Harrington, Robert A
AU  - Harrington RA
FAU - Yadav, Jay S
AU  - Yadav JS
FAU - Pieper, Karen S
AU  - Pieper KS
FAU - Gallup, Dianne
AU  - Gallup D
FAU - Dyke, Christopher
AU  - Dyke C
FAU - Roe, Matthew T
AU  - Roe MT
FAU - Berdan, Lisa
AU  - Berdan L
FAU - Lauer, Michael S
AU  - Lauer MS
FAU - Manttari, Matti
AU  - Manttari M
FAU - White, Harvey D
AU  - White HD
FAU - Califf, Robert M
AU  - Califf RM
FAU - Topol, Eric J
AU  - Topol EJ
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Acetates)
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 42HK56048U (Tyrosine)
RN  - 9005-49-6 (Heparin)
RN  - 9XOE28082S (lamifiban)
SB  - IM
MH  - Acetates/*therapeutic use
MH  - Acute Disease
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - Coronary Disease/*drug therapy/physiopathology/therapy
MH  - Data Interpretation, Statistical
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Revascularization
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - Randomized Controlled Trials as Topic
MH  - Survival Analysis
MH  - Tyrosine/*analogs & derivatives/*therapeutic use
EDAT- 2002/12/18 04:00
MHDA- 2003/01/17 04:00
CRDT- 2002/12/18 04:00
PHST- 2002/12/18 04:00 [pubmed]
PHST- 2003/01/17 04:00 [medline]
PHST- 2002/12/18 04:00 [entrez]
AID - S0002870302002235 [pii]
AID - 10.1067/mhj.2002.126118 [doi]
PST - ppublish
SO  - Am Heart J. 2002 Dec;144(6):995-1002. doi: 10.1067/mhj.2002.126118.