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Titolo:
A randomized, placebo-controlled trial of enoxaparin after high-risk coronary stenting: The ATLAST trial
Autore:
Batchelor, WB; Mahaffey, KW; Berger, PB; Deutsch, E; Meier, S; Hasselblad, V; Fry, ET; Teirstein, PS; Ross, AM; Binanay, CA; Zidar, JP;
Indirizzi:
Duke Clin Res Inst, Durham, NC USA Duke Clin Res Inst Durham NC USADuke Clin Res Inst, Durham, NC USA Mayo Clin & Mayo Fdn, Rochester, MN 55905 USA Mayo Clin & Mayo Fdn Rochester MN USA 55905 Fdn, Rochester, MN 55905 USA New York Presbyterian Hosp, New York, NY USA New York Presbyterian Hosp New York NY USA terian Hosp, New York, NY USA Aventis Pharma, Bridgewater, NJ USA Aventis Pharma Bridgewater NJ USAAventis Pharma, Bridgewater, NJ USA St Vincents Hosp, Indianapolis, IN USA St Vincents Hosp Indianapolis IN USA Vincents Hosp, Indianapolis, IN USA Scripps Clin, La Jolla, CA USA Scripps Clin La Jolla CA USAScripps Clin, La Jolla, CA USA George Washington Univ, Washington, DC 20052 USA George Washington Univ Washington DC USA 20052 , Washington, DC 20052 USA
Titolo Testata:
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
fascicolo: 6, volume: 38, anno: 2001,
pagine: 1608 - 1613
SICI:
0735-1097(20011115)38:6<1608:ARPTOE>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
MOLECULAR-WEIGHT HEPARINS; WAVE MYOCARDIAL-INFARCTION; UNFRACTIONATED HEPARIN; CLINICAL OUTCOMES; MULTICENTER; THROMBOSIS; THERAPY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Zidar, JP Duke Univ, Med Ctr, 7405 Hosp N,Box 3290,Erwin Rd, Durham, NC 27710 USA Duke Univ 7405 Hosp N,Box 3290,Erwin Rd Durham NC USA 27710 USA
Citazione:
W.B. Batchelor et al., "A randomized, placebo-controlled trial of enoxaparin after high-risk coronary stenting: The ATLAST trial", J AM COL C, 38(6), 2001, pp. 1608-1613

Abstract

OBJECTIVES We performed a multicenter, double-blind placebo-controlled trial to examine the efficacy and safety of enoxaparin in patients at high risk for stent thrombosis (ST). BACKGROUND The optimal antithrombotic regimen for such patients is unknown. METHODS We randomized 1,102 patients with clinical, angiographic or ultrasonographic features associated with an increased risk of ST to receive either twice-daily injections of weight-adjusted enoxaparin or placebo for 14 days after stenting. All patients received aspirin and ticlopidine. The primary end point was a 30-day composite end point of death, myocardial infarction (MI) or urgent revascularization. RESULTS The target enrollment for the study was 2,000 patients. However, the trial was terminated prematurely at 1,102 patients after interim analysis revealed an unexpectedly low event rate. The primary outcome occurred in 1.8% enoxaparin-treated patients versus 2.7% treated with placebo (odds ratio [OR] 0.66; 95% confidence interval [CI] 0.29 to 1.5, p = 0.30); for death or Ml the rates were 0.9% vs. 2.2%, respectively (OR 0.41, 95% CI 0.14 to1.2, p = 0.13); and for MI, 0.4% vs. 1.6%, respectively (OR 0.22, 95% CI 0.05 to 0.99, p = 0.04). The groups had comparable rates of major bleeding (3.3% for enoxaparin, 1.6% for placebo, p = 0.08), but minor nuisance bleeding was increased with enoxaparin (25% vs. 5.1%, p < 0.001). CONCLUSIONS The clinical outcomes of patients at increased risk of ST are more favorable than previously reported, rendering routine oral antiplatelet therapy adequate for most. However, given its relative safety and potential to reduce the risk of subsequent infarction, a 14-day course of enoxaparin may be considered for carefully selected patients. (C) 2001 by the American College of Cardiology.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 13/07/20 alle ore 07:54:05