Low molecular weight heparin in coronary stenting.

A pilot clinical study called Enoxaparin and Ticlopidine after Elective Stenting (ENTICES) was designed to determine whether the combination of enoxaparin, ticlopidine and acetylsalicylic acid (ASA) is superior to the conventional five-drug regimen routinely used after elective stent placement (warfarin, unfractionated heparin, dextran, dipyridamole and ASA). Compared with patients on conventional therapy (44), those randomly assigned to enoxaparin and ticlopidine (79) had a lower composite rate of in-hospital bleeding and vascular complications (5% versus 16%; P = 0.005), a significantly lower composite end-point rate (death, nonfatal myocardial infarction, stent thrombosis of urgent revascularization) at 30 days (5% versus 20%; P = 0.001), a significantly lower incidence of stent thrombosis in the first 30 days (0% versus 7%; P = 0.04) and the same incidence of death or repeat angioplasty at six months. The Antiplatelet Therapy versus Lovenox plus Antiplatelet Therapy for Patients with an Increased Risk of Stent Thrombosis (ATLAST) trial was subsequently designed to compare the efficacy of the combination therapy enoxaparin. ASA and ticlopidine with that of antiplatelet therapy alone after coronary stent placement in patients at increased risk of stent thrombosis. Target enrolment of 2000 patients began in December 1996 and is expected to be complete by the end of 1998. In summary, the ENTICES pilot study demonstrated that the low molecular weight heparin enoxaparin is safe and effective for use with ASA and ticlopidine for elective stent patients. The ATLAST trial should provide results on whether enoxaparin is beneficial in patients at high risk for stent thrombosis.