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(Circulation. 2002;105:316.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Randomized, Placebo-Controlled Trial of Titrated Intravenous Lamifiban for Acute Coronary Syndromes

, The Platelet IIb/IIIa Antagonist for the Reduction of Acute coronary syndrome events in a Global Organization Network (PARAGON)-B Investigators

From the Platelet IIb/IIIa Antagonist for the Reduction of Acute coronary syndrome events in a Global Organization Network.

Correspondence to Robert A. Harrington, MD, Duke Clinical Research Institute, Room 0311 Terrace Level, 2400 Pratt St, Durham, NC 27705. E-mail harri019{at}mc.duke.edu

Background— Platelet glycoprotein IIb/IIIa inhibitors reduce the rate of death or myocardial infarction among patients with acute coronary syndromes without persistent ST-segment elevation, but their effects may depend on plasma concentrations. We tested whether the addition of lamifiban, titrated to achieve target plasma concentrations, to standard care would improve clinical outcomes.

Methods and Results— We randomized 5225 patients at 389 centers in 29 countries to receive a bolus and 72-hour infusion of lamifiban or placebo, adjusted for renal function, with aspirin and heparin. The primary end point was the composite of death, myocardial infarction, or severe, recurrent ischemia at 30 days. Baseline characteristics did not differ significantly by treatment. The primary end point occurred in 11.8% of lamifiban-treated patients and in 12.8% of placebo-treated patients (OR, 0.914; 95% CI, 0.769 to 1.087; P=0.329). Bleeding was more common in lamifiban-treated patients, but intracranial hemorrhage was not increased. Among the subgroup who had plasma lamifiban concentrations measured, 91% had a concentration >18 ng/mL at steady state, but their outcomes did not differ from those with lower concentrations.

Conclusions— Lamifiban showed no significant effects on clinical outcomes in patients with non–ST-elevation acute coronary syndromes, despite achievement of adequate plasma concentrations.

Key Words: angina • myocardial infarction • platelets

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