Design

• Multicenter, open-label study, randomized 3987 patients with non–ST-elevation (NSTE) acute coronary syndromes (ACS) in the previous 24 hours to receive acetylsalicylic acid (ASA) plus AGGRASTAT (10 µg/kg over three minutes followed by a 0.1 µg/kg/min infusion for 48 to 120 hours) plus either enoxaparin or unfractionated heparin (UFH).
• The overall strategy (early invasive vs. early conservative) was at the local investigator’s discretion.
• The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), or refractory ischemia within seven days of AGGRASTAT initiation.

Results

• AGGRASTAT, enoxaparin, and ASA had comparable efficacy to AGGRASTAT, UFH, and ASA, as assessed by the primary endpoint (8.4% vs. 9.4%, respectively; hazard ratio 0.88; 95% confidence interval 0.71–1.08).
• The study also showed a comparable incidence of urgent coronary revascularization at seven days.
• Both treatments produced very low rates of bleeding events.

Conclusion

• In patients receiving AGGRASTAT and ASA, enoxaparin is a suitable alternative to UFH for treatment of NSTE ACS.
• Low rates of bleeding and transfusion, despite aggressive use of cardiac catheterization and percutaneous coronary intervention, support the safety profile of the combination of enoxaparin and AGGRASTAT

The results of the A to Z Trial showed that the risk of death, MI, or refractory ischemia was comparable among patients with NSTE ACS who received AGGRASTAT and ASA combined with either enoxaparin or UFH.
Adapted from Blazing et al.⁴
NS = not significant