Published online before print July 21, 2003, doi: 10.1161/01.CIR.0000084501.48570.F6
(Circulation. 2003;108:399.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Randomized, Double-Blind, Placebo-Controlled, International Trial of the Oral IIb/IIIa Antagonist Lotrafiban in Coronary and Cerebrovascular Disease
From The Cleveland Clinic Foundation (E.J.T.), Cleveland, Ohio; Rhode Island Hospital-Brown University (D.E.), Providence, RI; Duke University Medical Center (R.A.H., R.M.C., C.G., K.S., K.P., M.V.), Durham, NC; Hospital Lariboisiere (P.A.), Paris, France; Royal Melbourne Hospital (S.D.), Victoria, Australia; University of Essen (H.-C.D.), Essen, Germany; Texas Heart Institute (J.F.), Houston, Tex; Royal College of Surgeons (D.F.), Dublin, Ireland; Rosemont, Pa (J.G.); University of Alberta (A.S.), Edmonton, Alberta, Canada; University Hospital (P.J.K.), Rotterdam, the Netherlands; Institute de Cardiologic de Montreal (P.T.), Quebec, Canada; University Hospital (F.V.d.W.), Leuven, Belgium; and University of Texas Medical School (J.T.W.), Houston, Tex.
Correspondence to Eric Topol, MD, Desk F25, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail topole{at}ccf.org
Received May 20, 2003; revision received June 10, 2003; accepted June 10, 2003.
Background— This is the primary report of the large-scale evaluation of lotrafiban, an orally administered IIb/IIIa receptor antagonist, a unique trial with respect to the platelet antagonist, protocol design, and inclusion of cerebrovascular disease in a significant proportion of patients.
Methods and Results— Patients with vascular disease were randomized to lotrafiban 30 or 50 mg BID on the basis of age and predicted creatinine clearance or placebo in addition to aspirin at a dose ranging from 75 to 325 mg/d at the discretion of the physician-investigator. Follow-up was for up to 2 years. The primary end point was the composite of all-cause mortality, myocardial infarction, stroke, recurrent ischemia requiring hospitalization, and urgent revascularization. Of 9190 patients enrolled from 23 countries and 690 hospitals, 41% had cerebrovascular disease at the time of entry, and 59% had coronary artery disease. Death occurred in 2.3% of placebo-assigned patients and 3.0% of lotrafiban-group patients (hazard ratio 1.33, 95% CI 1.03 to 1.72, P=0.026), and the cause of excess death was vascular related. There was no significant difference in the primary end point (17.5% compared with 16.4%, respectively; hazard ratio 0.94, 95% CI 0.85 to 1.03, P=0.19). Serious bleeding was more frequent in the lotrafiban group (8.0% compared with 2.8%; P<0.001). Serious bleeding was more common among patients who received higher doses of aspirin (>162 mg/d), with or without lotrafiban.
Conclusions— Lotrafiban, an orally administered platelet glycoprotein IIb/IIIa blocker, induced a 33% increase in death rate, which was vascular in origin and not affected by the type of atherosclerotic involvement at entry to the trial. Although the dose of aspirin was not randomly assigned, the finding of increased bleeding with doses >162 mg/d is noteworthy.
Key Words: antiplatelets • atherosclerosis • thrombosis
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