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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.

Publication ,  Journal Article
Sinnaeve, PR; Huang, Y; Bogaerts, K; Vahanian, A; Adgey, J; Armstrong, PW; Wallentin, L; Van de Werf, FJ; Granger, CB ...
Published in: Am Heart J
October 2006

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.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2006

Volume

152

Issue

4

Start / End Page

684.e1 / 684.e9

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Odds Ratio
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hemorrhage
  • Fibrinolytic Agents
 

Citation

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Sinnaeve, P. R., Huang, Y., Bogaerts, K., Vahanian, A., Adgey, J., Armstrong, P. W., … ASSENT-3 and ASSENT-3 PLUS investigators, . (2006). 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. Am Heart J, 152(4), 684.e1-684.e9. https://doi.org/10.1016/j.ahj.2006.07.005
Sinnaeve, Peter R., Yao Huang, Kris Bogaerts, Alec Vahanian, Jennifer Adgey, Paul W. Armstrong, Lars Wallentin, Frans J. Van de Werf, Christopher B. Granger, and Christopher B. ASSENT-3 and ASSENT-3 PLUS investigators. “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.Am Heart J 152, no. 4 (October 2006): 684.e1-684.e9. https://doi.org/10.1016/j.ahj.2006.07.005.
Sinnaeve, Peter R., et al. “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.Am Heart J, vol. 152, no. 4, Oct. 2006, pp. 684.e1-684.e9. Pubmed, doi:10.1016/j.ahj.2006.07.005.
Sinnaeve PR, Huang Y, Bogaerts K, Vahanian A, Adgey J, Armstrong PW, Wallentin L, Van de Werf FJ, Granger CB, ASSENT-3 and ASSENT-3 PLUS investigators. 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. Am Heart J. 2006 Oct;152(4):684.e1-684.e9.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2006

Volume

152

Issue

4

Start / End Page

684.e1 / 684.e9

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Odds Ratio
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hemorrhage
  • Fibrinolytic Agents