Antithrombin therapy, antiplatelet therapy and percutaneous coronary intervention: rationale and design of the SYNERGY trial
Texas Heart Institute, Houston, Texas, USA
* Correspondence: James J. Ferguson, MD, Associate Director, Cardiology Research, Texas Heart Institute, St. Luke's Episcopal Hospital, 6720 Benner Avenue, Mail Code 1-191, Houston, TX 77030, USA
Abstract
Although low-molecular-weight heparins (LMWHs) have been shown to be equivalent or superior to unfractionated heparin for the management of patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI), a number of clinical issues remain. Among them are the safety of bringing patients to the catheterization laboratory and the use of glycoprotein (GP)Ilb/Illa antagonists. The Superior Yield of the New strategy of Enoxaparin, Revascularization and GlYcoprotein IIb/IIIa inhibitors (SYNERGY) trial is a randomized study comparing the safety and efficacy of unfractionated heparin and the LMWH enoxaparin in high-risk, invasively managed UA/NSTEMI patients who are likely to receive GPIIb/IIIa antagonists.
Key Words: Heparin low-molecular-weight heparin percutaneous atherectomy platelet glycoprotein IIb/IIIa receptor antagonist/inhibitor unstable angina
References
- Granger C, Lopez-Sendon J, Werf FVd, et al. Applying the evidence in acute coronary syndromes: a report card from the global registry of acute coronary events [abstract]. J Am Coll Cardiol. 2001;37:503A
- Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med. 1992;326:310318[Web of Science][Medline]
- Oler A, Whooley MA, Oler J, Grady D. Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina. A meta-analysis. JAMA. 1996;276:811815
[Abstract/Free Full Text] - Wallentin L. Low molecular weight heparin in unstable coronary artery disease. Expert Opin Investig Drugs. 2000;9:581592[CrossRef][Web of Science][Medline]
- Antman EM, Cohen M, Radley D, et al. Assessment of the treatment effect of enoxaparin for unstable angina/non-Q-wave myocardial infarction. TIMI 11B-ESSENCE meta-analysis. Circulation. 1999;100:16021608
[Abstract/Free Full Text] - AnonymousLancet. 1996;347:561568[CrossRef][Web of Science][Medline]
- Klein W, Buchwald A, Hillis SE, et al. Comparison of lowmolecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Fragmin in Unstable Coronary Artery Disease study (ERIC). Circulation. 1997;96:6168
[Abstract/Free Full Text] - Antman EM, McCabe CH, Gurfinkel EP, et al. Enoxaparin prevents death and cardiac ischemic events in unstable angina/ non-Q-wave myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) I1B trial. Circulation. 1999;100:15931601
[Abstract/Free Full Text] - Cohen M, Demers C, Gurfinkel EP, et al. A comparison of lowmolecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events study group. N Engl J Med. 1997;337:447452
[Abstract/Free Full Text] - Goodman SG, Cohen M, Bigonzi F, et al. Randomized trial of low molecular weight heparin (enoxaparin) versus unfractionated heparin for unstable coronary artery disease: One-year results of the ESSENCE study. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events. J Am Coll Cardiol. 2000;36:693698
[Abstract/Free Full Text] - Collignon F, Frydman A, Caplain H, et al. Comparison of the pharmacokinetic profiles of three low molecular mass heparins - dalteparin, enoxaparin and nadroparin - administered sub cutaneously in healthy volunteers (doses for prevention of thromboembolism). Thromb Haemost. 1995;73:630640[Web of Science][Medline]
- AnonymousEur Heart J. 1999;20:15531562
[Abstract/Free Full Text] - Boden WE, O'Rourke RA, Crawford MH, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative manage ment strategy. Veterans Affairs Non-Q-wave Infarction Strategies in Hospital (VANQWISH) trial investigators. N Engl J Med. 1998;338:17851792
[Abstract/Free Full Text] - AnonymousLancet. 1999;354:708715[CrossRef][Web of Science][Medline]
- Rabah MM, Premmereur J, Graham M, et al. Usefulness of intravenous enoxaparin for percutancous coronary intervention in stable angina pectoris. Am J Cardiol. 1999;84:13911395[CrossRef][Web of Science][Medline]
- Diez JG, Lievano MJ, Croitoru M, Olay CA, Ferguson JJ. Enoxaparin anticoagulation for percutancous coronary interventions: a pilot safety study [abstract]. Circulation. 1999;100:I188
- Collet JP, Montalescot G, Lison L, et al. Percutaneous coronary intervention after subcutaneous enoxaparin pretreatment in patients with unstable angina pectoris. Circulation. 2001;103:658663
[Abstract/Free Full Text] - Cohen M, Theroux P, Frey MJ, et al. Anti-thrombotic Combination using Tirofiban and Enoxaparin: the ACUTE 11 study [abstract]. Circulation. 2000;102:II826
- Simoons ML. Effect of glycoprotein iib/iiia receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularisation: The GUSTO IV-ACS randomised trial. Lancet. 2001;357:19151924[CrossRef][Web of Science][Medline]
- Kereiakes DJ, Grines C, Fry E, et al. Enoxaparin and abciximab adjunctive pharmacotherapy during percutaneous coronary intervention. J Invasive Cardiol. 2001;13:272278[Medline]
- AnonymousLancet. 1998;352:8792[Web of Science][Medline]
- AnonymousN Engl J Med. 1997;336:16891696
[Abstract/Free Full Text] - Ferguson JJ. Combining low-molecular-weight heparin and glycoprotein IIb/Ilia antagonists for the treatment of acute coronary syndromes: The NICE 3 story. National Investigators Collaborating on Enoxaparin. J Invasive Cardiol. 2000;12(suppl E):E10E13 discussion E25-8
- Ferguson JJ, Antman EM, Bates ER, et al. The use of enoxaparin and IIb/IIIa antagonists in acute coronary syndromes, including PCI: Final results of the NICE 3 study [abstract]. J Am Coll Cardiol. 2001;37(suppl A):365A
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