@article{04ec4be41e164066b4ff2781eedd2de8,
title = "Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: The ASSENT-3 randomised trial in acute myocardial infarction",
abstract = "Background: Current fibrinolytic therapies fail to achieve optimum reperfusion in many patients. Low-molecular-weight heparins and platelet glycoprotein IIb/IIIa inhibitors have shown the potential to improve pharmacological reperfusion therapy. We did a randomised, open-label trial to compare the efficacy and safety of tenecteplase plus enoxaparin or abciximab, with that of tenecteplase plus weight-adjusted unfractionated heparin in patients with acute myocardial infarction. Methods: 6095 patients with acute myocardial infarction of less than 6 h were randomly assigned one of three regimens: full-dose tenecteplase and enoxaparin for a maximum of 7 days (enoxaparin group; n=2040), half-dose tenecteplase with weight-adjusted low-dose unfractionated heparin and a 12-h infusion of abciximab (abciximab group; n=2017), or full-dose tenecteplase with weight-adjusted unfractionated heparin for 48 h (unfractionated heparin group; n=2038). The primary endpoints were the composites of 30-day mortality, in-hospital reinfarction, or in-hospital refractory ischaemia (efficacy endpoint), and the above endpoint plus in-hospital intracranial haemorrhage or in-hospital major bleeding complications (efficacy plus safety endpoint). Analysis was by intention to treat. Findings: There were significantly fewer efficacy endpoints in the enoxaparin and abciximab groups than in the unfractionated heparin group: 233/2037 (11.4%) versus 315/2038 (15.4%; relative risk 0.74 [95% CI 0.63-0.87], p=0.0002) for enoxaparin, and 223/2017 (11.1%) versus 315/2038 (15.4%; 0.72 [0.61-0.84], p<0.0001) for abciximab. The same was true for the efficacy plus safety endpoint: 280/2037 (13.7%) versus 347/2036 (17.0%; 0.81 [0.70-0.93], p=0.0037) for enoxaparin, and 287/2016 (14.2%) versus 347/2036 (17.0%; 0.84 [0.72-0.96], p=0.01416) for abciximab. Interpretation: The tenecteplase plus enoxaparin or abciximab regimens studied here reduce the frequency of ischaemic complications of an acute myocardial infarction. In light of its ease of administration, tenecteplase plus enoxaparin seems to be an attractive alternative reperfusion regimen that warrants further study.",
author = "{The Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 Investigators} and {Van de Werf}, F. and Armstrong, {P. W.} and C. Granger and L. Wallentin and Adgey, {A. A.J.} and P. Aylward and Binbrek, {A. S.} and R. Califf and S. Cassim and R. Diaz and R. Fanebust and Fioretti, {P. M.} and K. Huber and S. Husted and B. Lindahl and L{\'o}pez-Send{\'o}n, {J. L.} and M. M{\"a}kij{\"a}rvi and J. Meyer and {Navarro Robles}, J. and M. Pfisterer and R. Seabra-Gomes and L. Soares-Piegas and D. Sugrue and M. Tendera and P. Theroux and P. Toutouzas and A. Vahanian and F. Verheugt and H. Sarelin and G. Goetz and E. Bluhmki and V. Daclin and T. Danays and K. Houbracken and J. Kaye and P. Reilly and W. Hacke and {von Kummer}, R. and E. Lesaffre and K. Bogaerts and C. Peeters and Fox, {K. A.A.} and R. Brower and J. Hirsh and A. Maggioni and J. Tijssen and D. Weaver and A. Beernaert and N. Beysen and K. Broos and {De Prins}, E. and K. D{\textquoteright}hollander and L. Dupon and N. Fomyna and A. Fransen and D. Genesse and L. Goffin and R. Hendrickx and B. Jansen and F. Jorissen and C. Luys and A. Luyten and C. Marschal and M. Moreira and K. Munsters and R. Salerno and C. Schoovaerts and P. Sinnaeve and C. Schildermans and K. Vandenberghe and K. Vandeschoot and {Van Gucht}, H. and {Van Rompaey}, P. and S. Vlassak and M. Watzeels and H. Wittockx and K. Galan and L. Humeniuk and A. Seidel and M. Molina and G. Hafley and J. Alexander and A. Pascual and S. Bestilny and T. Temple and {Ahuad Guerrero}, R. and Albisu, {J. P.} and {Bassani Arrieta}, {C. A.} and J. Bono and A. Caccavo and A. Cagnolatti and Cartasegna, {L. R.} and R. Castellanos and S. Chekerdemian and G. Covelli and Cuello, {J. L.} and Cuneo, {C. A.} and A. Fernandez and C. Ferrara and E. Ferro-Queirel and A. Gambarte and R. Garcia-Duran and E. Hasbani and A. Hrabar and L. Keller and {Lobo Marquez}, {L. L.} and H. Luciardi and Macin, {S. M.} and A. Marinig and E. Marzetti and J. Muntaner and R. Nordaby and Orlandini, {A. D.} and Piombo, {A. C.} and Pomposiello, {J. C.} and Quijano, {R. A.} and J. Amerena and G. Aroney and N. Buckmaster and P. Carroll and M. Fitzpatrick and R. Newman and M. Rowe and B. Singh and A. Thomson and C. Winter and B. Eber and Gaul, {G. B.} and W. Klein and F. Leisch and H. Mayr and J. Mlczoch and H. Niessner and O. Pachinger and H. Pall and M. Pichler and G. R{\"o}ggla and E. Schaflinger and W. Schreiber and J. Slany and O. Traindl and G. Zenker and J. Beckers and I. Bekaert and C. Berthe and G. Bodur and B. Carlier and M. Carlier and J. Carpentier and H. Celen and F. Charlier and A. Clement and A. Coenen and L. Crochelet and {De Keyser}, F. and {De Man}, F. and {de Meester}, A. and P. Dendale and E. Dhondt and G. Dhooghe and {El Allaf}, D. and S. Elshot and C. Emmerechts and F. Foret and E. Gatera and J. Geraedts and Gerardy, {A. C.} and M. Gysbrechts and R. Hallemans and S. Hellemans and H. Herssens and L. Huygens and L. Janssens and J. Lalmand and R. Maamar and P. Marechal and D. Mertens and P. Michel and E. Morandini and M. Nannan and D. Nguyen and W. Odeurs and P. Peerenboom and B. Pirenne and M. Quinonez and E. Raymenants and M. Renard and Silance, {P. G.} and Standaert, {A. M.} and H. Striekwold and H. Thiels and D. Valadi and {van Brabandt}, H. and {Van Dormael}, M. and {Van Iseghem}, P. and {Van Walleghem}, U. and {Vanden Bosch}, H. and Vandenbossche, {J. L.} and J. Vermylen and S. Verstraete and {Vo Ngoc}, P. and P. Willems and R. Zenner and {Campos de Albuquerque}, D. and M. Coutinho and {de Camargo Carvalho}, {A. C.} and {Fernandes Manenti}, {E. R.} and {Ferreira Azevedo}, A. and V. Golin and C. Gun and {Marin Neto}, {J. A.} and Marino, {R. L.} and {Miranda Abrantes}, {J. A.} and Nicolau, {J. C.} and {Porto Alegre Dancini}, {E. M.} and A. Rabelo and Ramos, {R. F.} and {Rizzi Coelho}, O. and D. Alexander and M. Henderson and H. Smith and J. Petersen and P. Pfeiffer and A. Brown and J. Horgan and Arnold, {A. E.R.} and H. Wang and D. Ferreira and Benjamin, {J. D.} and S. George and Rao, {K. N.} and Kendall, {J. M.} and Rose, {E. L.} and J. Stephens and J. Bennett and J. Chin and Church, {D. H.} and R. Clark and Foreman, {R. D.} and J. Hawkins and J. King and C. Lee and Lee, {A. B.} and Miller, {M. J.} and Miller, {M. S.} and J. Miller and N. Patel and Rees, {A. P.} and Ryan, {P. F.} and G. Singh",
year = "2001",
month = aug,
day = "25",
doi = "10.1016/S0140-6736(01)05775-0",
language = "English",
volume = "358",
pages = "605--613",
journal = "Lancet",
issn = "0140-6736",
publisher = "Lancet",
number = "9282",
}