Evidence-Based Management of ACSEnoxaparin and glycoprotein IIb/IIIa inhibition in non–ST-elevation acute coronary syndrome: Insights from the INTERACT trial
Section snippets
Methods
A detailed description of the INTERACT design and results has been previously published.3 To be eligible, patients were required to have ischemic chest pain at rest and either significant ST-segment deviation (ST-segment depression ≥0.1 mV or transient ST-segment elevation ≥0.1 mV in ≥2 contiguous leads) or elevated serum markers (cardiac troponin I or T ≥3 times the upper reference limit, or creatine kinase-MB > upper limit of normal). Patients with increased risk of bleeding; renal failure;
Results
INTERACT enrolled 746 patients from 50 hospitals across Canada. Details of study drug administration are shown in Table I. Approximately 20% of patients received UFH or enoxaparin before randomization, but in both treatment groups, time between symptom onset and randomization was relatively short. The duration of eptifibatide infusion was the specified 48 hours. There was more variability in the administration of the two anticoagulants, and the median duration of UFH treatment was 8 hours
Discussion
By requiring definitive ECG changes or elevation of cardiac markers, INTERACT enrolled a high-risk subset of NSTE ACS patients. Current treatment guidelines recommend use of a GP IIb/IIIa inhibitor as well as an early invasive management strategy in this population, but the appropriate role of enoxaparin in this setting has been a subject of debate.14, 15 INTERACT was initiated at a time when the advantages of an early invasive strategy were not definitively established. The trial compared
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