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(Circulation. 2007;115:2642-2651.)
© 2007 American Heart Association, Inc.

Interventional Cardiology

Randomized, Double-Blind, Dose-Ranging Study of Otamixaban, a Novel, Parenteral, Short-Acting Direct Factor Xa Inhibitor, in Percutaneous Coronary Intervention

The SEPIA-PCI Trial

Marc Cohen, MD; Deepak L. Bhatt, MD; John H. Alexander, MD; Gilles Montalescot, MD; Christoph Bode, MD; Timothy Henry, MD; Jean-Francois Tamby, MD; Jan Saaiman, MD; Stanislas Simek, MD; Johannes De Swart, MD, on behalf of the SEPIA-PCI Trial Investigators

From the Division of Cardiology (M.C.), Newark Beth Israel Medical Center, Newark, NJ; Cleveland Clinic (D.L.B.), Cleveland, Ohio; Duke University Medical Center (J.H.A.), Durham, NC; Hopital La Pitié Salpétrière (G.M.), Paris, France; University of Freiburg Medical Center (C.B.), Freiburg, Germany; Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.H.), Minneapolis, Minn; sanofi-aventis (J.-F.T.), Bridgewater, NJ; Kuols River Private Hospital (J.S.), Capetown, South Africa; General University Hospital (S.S.), Prague, Czech Republic; and Medical Center (J.D.S.), Alkmaar, the Netherlands.

Correspondence to Marc Cohen, MD, FACC, Cardiac Catheterization Lab Administration, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112. E-mail marcohen{at}sbhcs.com

Received July 24, 2006; accepted March 9, 2007.

Background— The optimal anticoagulant regimen for percutaneous coronary intervention (PCI) remains to be determined. Otamixaban, a selective and direct inhibitor of factor Xa, was investigated in patients undergoing nonurgent percutaneous coronary intervention.

Methods and Results— In this double-blind, double-dummy, parallel-group, dose-ranging trial, 947 patients were randomly assigned to either 1 of 5 weight-adjusted otamixaban regimens or weight-adjusted unfractionated heparin (UFH) before percutaneous coronary intervention. The primary end points were change in prothrombin fragments 1+2 (F1+2), and anti-factor Xa activity. The main secondary end points were Thrombolysis In Myocardial Infarction (TIMI) bleeding at day 3 or hospital discharge (whichever came first) and 30-day ischemic events. The median change in F1+2 from baseline to the end of infusion was greater with the highest otamixaban dose compared with UFH (–0.3 versus –0.2 ng/mL, P=0.008). Anti-factor Xa levels were 65, 155, 393, 571, and 691 ng/mL with otamixaban doses 1 to 5, respectively. Significant TIMI bleeding (major or minor) occurred in 2.0%, 1.9%, 3.8%, 3.9%, and 2.6% of patients receiving otamixaban doses 1 to 5, respectively, and in 3.8% of patients receiving UFH. Four TIMI major bleeds were observed. Ischemic events occurred in 5.8%, 7.1%, 3.8%, 2.5%, and 5.1% of patients receiving otamixaban doses 1 to 5, respectively, and in 5.6% of patients receiving UFH.

Conclusions— Otamixaban reduced F1+2 significantly more than UFH at the highest dose regimen, whereas no significant difference in the incidence of TIMI bleeding was observed between the otamixaban and UFH groups. These results set the stage for adequately powered clinical outcome trials of selective direct factor Xa inhibition in patients with acute coronary syndromes.

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