PMID- 16996833
OWN - NLM
STAT- MEDLINE
DCOM- 20061018
LR  - 20071115
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 152
IP  - 4
DP  - 2006 Oct
TI  - Age, outcomes, and treatment effects of fibrinolytic and antithrombotic 
      combinations: findings from Assessment of the Safety and Efficacy of a New 
      Thrombolytic (ASSENT)-3 and ASSENT-3 PLUS.
PG  - 684.e1-9
AB  - BACKGROUND: Elderly patients with acute myocardial infarction are at particularly 
      high risk for death and bleeding complications. The efficacy and safety of 
      antithrombotic strategies in these patients remain unclear. METHODS: To provide 
      more insight into the risk and benefit of antithrombotic strategies in the 
      elderly, we examined patients from the ASSENT-3 and ASSENT-3 PLUS trials with 
      STEMI who were treated with tenecteplase (TNK) and unfractionated heparin (UFH) 
      or enoxaparin, or half-dose TNK with abciximab and reduced-dose UFH. RESULTS: 
      Older patients had a higher risk profile, and lower use of concomitant therapies 
      and revascularization procedures. We found an interaction between age and 
      treatment effect for the efficacy end point (P = .0007) and the efficacy plus 
      safety end point (P < .0001). Younger patients (<65 years) had a lower risk of 
      the composite efficacy plus safety end point with enoxaparin (relative risk [RR] 
      0.84, 95% CI 0.74-0.94) or abciximab (RR 0.79, 95% CI 0.69-0.90) compared with 
      UFH. In patients >65 years of age, the benefit of enoxaparin appeared to be 
      offset by an increased risk of bleeding complications. The risk of the efficacy 
      plus safety end point tended to be higher in elderly patients receiving abciximab 
      and half-dose TNK (RR 1.18, 95% CI 0.91-1.51 for 76-85 years of age and RR 1.48, 
      95% CI 0.88-2.49 for >85 years of age). CONCLUSIONS: Although TNK with either 
      enoxaparin or abciximab appeared to be more effective than with standard UHF in 
      younger patients, these combinations tended to be less effective and even may be 
      unsafe in the elderly. Development of new combination strategies and dosing 
      schemes of fibrinolytics and antithrombotics with improved efficacy and safety in 
      the elderly remains a high priority.
FAU - Sinnaeve, Peter R
AU  - Sinnaeve PR
AD  - Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium. 
      peter.sinnaeve@uz.kuleuven.ac.be
FAU - Huang, Yao
AU  - Huang Y
FAU - Bogaerts, Kris
AU  - Bogaerts K
FAU - Vahanian, Alec
AU  - Vahanian A
FAU - Adgey, Jennifer
AU  - Adgey J
FAU - Armstrong, Paul W
AU  - Armstrong PW
FAU - Wallentin, Lars
AU  - Wallentin L
FAU - Van de Werf, Frans J
AU  - Van de Werf FJ
FAU - Granger, Christopher B
AU  - Granger CB
CN  - ASSENT-3 and ASSENT-3 PLUS investigators
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - *Aging
MH  - Dose-Response Relationship, Drug
MH  - Drug Therapy, Combination
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Hemorrhage/etiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/complications/*drug therapy/mortality
MH  - Odds Ratio
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Treatment Outcome
EDAT- 2006/09/26 09:00
MHDA- 2006/10/19 09:00
CRDT- 2006/09/26 09:00
PHST- 2005/10/05 00:00 [received]
PHST- 2006/07/03 00:00 [accepted]
PHST- 2006/09/26 09:00 [pubmed]
PHST- 2006/10/19 09:00 [medline]
PHST- 2006/09/26 09:00 [entrez]
AID - S0002-8703(06)00631-4 [pii]
AID - 10.1016/j.ahj.2006.07.005 [doi]
PST - ppublish
SO  - Am Heart J. 2006 Oct;152(4):684.e1-9. doi: 10.1016/j.ahj.2006.07.005.