APRICOT-2

Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis Trial (2002)

Condition

Prevention of reocclusion and recurrent ischemic events after fibrinolysis for STEMI

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Objective

To assess the impact of a prolonged anticoagulation regimen as adjunctive to ASA in the prevention of reocclusion and recurrent ischemic events after fibrinolysis

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Trial design

Randomized, open study
Active treatment: ASA 80 mg once daily plus moderate-intensity warfarin, including continued heparinization until a target INR of 2.0–3.0 (n=157)
Control treatment: ASA 80 mg once daily (standard heparinization was discontinued after 48 hours) (n=151)

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Endpoints

Primary efficacy endpoint: reocclusion of the infarct-related artery at angiographic follow-up, defined as TIMI grade 2 flow or less
Secondary efficacy endpoint: event-free survival (a clinical course without death, reinfarction or revascularization)
Primary safety endpoint: TIMI major and minor bleeding

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Trial participants

308 patients ≤75 years receiving ASA and i.v. heparin, who had a patent infarct-related artery (TIMI grade 3 flow) 48 hours after fibrinolytic therapy of STEMI

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Results

Efficacy outcome: Reocclusion was observed in 19 of 123 patients (15%) receiving ASA and warfarin compared with 36 of 128 patients (28%) receiving ASA alone (relative risk reduction 45%). This was mainly due to a reduced incidence of TIMI grade 0–1 flow: 11 of 123 patients (9%) with ASA vs. 25 of 128 patients (20%) with ASA plus warfarin (relative risk reduction 54%). The event-free survival rate was significantly higher with combined treatment (86% vs. 66%)
Safety outcome: TIMI major and minor bleeding complications occurred in 7 patients (5%) in the combination treatment group (2 major, 5 minor) and in 4 (3%) in the ASA alone group (2 major, 2 minor). No cerebral bleeding was reported in either group

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Summary

Efficacy: After successful fibrinolysis, a 3-month-regimen of moderate-intensity warfarin as adjunctive to ASA markedly reduced the reocclusion and recurrent events compared to ASA alone
Safety: Bleeding complications occurred infrequently; there was no significant difference between the two groups

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Reference

Brouwer MA, van den Bergh PJ, Aengevaeren WRM, Veen G, Luijten HE, Hertzberger DP, van Boven AJ, Vromans RP, Uijen GJH, Verheugt FWA. Aspirin plus coumarin versus aspirin alone in the prevention of reocclusion after fibrinolysis for acute myocardial infarction. Results of the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis (APRICOT)-2 Trial. Circulation 2002;106:659-665

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Corresponding author

Freek W.A. Verheugt, MD, PhD, University Medical Center Nijmegen, Heartcenter, 540 Cardiology, PO Box 9101, Nijmegen, The Netherlands 6500 HB, e-mail: f.verheugt@cardio.umcn.nl

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