PMID- 15451146
OWN - NLM
STAT- MEDLINE
DCOM- 20050224
LR  - 20231024
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 25
IP  - 19
DP  - 2004 Oct
TI  - Enoxaparin versus unfractionated heparin in patients treated with tirofiban, 
      aspirin and an early conservative initial management strategy: results from the A 
      phase of the A-to-Z trial.
PG  - 1688-94
AB  - AIMS: In high risk patients with non-ST elevation acute coronary syndromes (ACS), 
      enoxaparin is generally preferred to unfractionated heparin (UFH). However, less 
      is known about the relative merits of these two forms of heparin in patients 
      receiving concomitant glycoprotein IIb/IIIa inhibitors. METHODS AND RESULTS: The 
      A phase of the A-to-Z trial was an open label non-inferiority trial in which 3987 
      patients with non-ST elevation ACS were randomised to receive either enoxaparin 
      or UFH in combination with aspirin and tirofiban. Inclusion required either ST 
      depression or cardiac biomarker elevation. While the selection of an early 
      management strategy (invasive or conservative) was at the discretion of the local 
      investigator, investigators were asked to designate their plans for an invasive 
      or conservative strategy on the case record form. An early conservative strategy 
      was specified for 1778 patients (45%); this subgroup forms the population for the 
      present analyses. Among patients with a planned conservative strategy, baseline 
      characteristics were similar between those randomised to UFH (n = 872) and those 
      randomised to enoxaparin (n = 906). The primary endpoint of death, new MI, or 
      documented refractory ischaemia within 7 days of randomisation occurred in 10.6% 
      of patients randomised to UFH and 7.7% of patients randomised to enoxaparin (HR 
      0.72; 95% CI 0.53-0.99; p = 0.04). The combined rate of TIMI major, minor, or 
      loss no-site bleeding was 1.3% in patients treated with UFH and 1.8% in those 
      treated with enoxaparin (p = ns). CONCLUSIONS: When a conservative approach to 
      catheterisation and PCI was planned for ACS patients receiving tirofiban and 
      aspirin, enoxaparin was associated with superior efficacy and similar bleeding vs 
      UFH.
FAU - de Lemos, James A
AU  - de Lemos JA
AD  - Donald W. Reynolds Cardiovascular Clinical Research Center, 5323 Harry Hines 
      Blvd, Rm HA 9.133, UT Southwestern Medical Center, Dallas, TX 75390-9047, USA. 
      james.delemos@utsouthwestern.edu
FAU - Blazing, Michael A
AU  - Blazing MA
FAU - Wiviott, Stephen D
AU  - Wiviott SD
FAU - Brady, William E
AU  - Brady WE
FAU - White, Harvey D
AU  - White HD
FAU - Fox, Keith A A
AU  - Fox KA
FAU - Palmisano, Joanne
AU  - Palmisano J
FAU - Ramsey, Karen E
AU  - Ramsey KE
FAU - Bilheimer, David W
AU  - Bilheimer DW
FAU - Lewis, Eldrin F
AU  - Lewis EF
FAU - Pfeffer, M
AU  - Pfeffer M
FAU - Califf, Robert M
AU  - Califf RM
FAU - Braunwald, Eugene
AU  - Braunwald E
CN  - Investigators
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 42HK56048U (Tyrosine)
RN  - 9005-49-6 (Heparin)
RN  - GGX234SI5H (Tirofiban)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
CIN - Eur Heart J. 2004 Oct;25(19):1667-9. PMID: 15451141
MH  - Aspirin/*therapeutic use
MH  - Coronary Disease/*drug therapy
MH  - Drug Therapy, Combination
MH  - Enoxaparin/*therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Tirofiban
MH  - Treatment Outcome
MH  - Tyrosine/*analogs & derivatives/*therapeutic use
EDAT- 2004/09/29 05:00
MHDA- 2005/02/25 09:00
CRDT- 2004/09/29 05:00
PHST- 2004/03/02 00:00 [received]
PHST- 2004/06/11 00:00 [revised]
PHST- 2004/06/17 00:00 [accepted]
PHST- 2004/09/29 05:00 [pubmed]
PHST- 2005/02/25 09:00 [medline]
PHST- 2004/09/29 05:00 [entrez]
AID - S0195-668X(04)00432-4 [pii]
AID - 10.1016/j.ehj.2004.06.028 [doi]
PST - ppublish
SO  - Eur Heart J. 2004 Oct;25(19):1688-94. doi: 10.1016/j.ehj.2004.06.028.