Semin Thromb Hemost 2005; 31(2): 248
DOI: 10.1055/s-2005-869530

Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662.

On “Current Role of Antithrombotic Agents in the Treatment of Acute Coronary Syndromes” (Semin Thromb Hemost 2004;30:627-632)

Christopher O. Nessel1
  • 1Executive Director, Clinical Development, The Medicines Company, Parsippany, New Jersey
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Publication History

Publication Date:
26 April 2005 (online)

I read with interest the article “Current Role of Antithrombotic Agents in the Treatment of Acute Coronary Syndromes” by Mukherjee and Bates (Semin Thromb Hemost 2004;30:627-632). Indeed, the management of ACS with respect to antithrombin therapy has yet to be precisely defined. Within the context of the treatise, the authors discuss the results of the ASSENT-3 trial. The safety parameters captured in this trial were in-hospital ICH and major bleeding (other than ICH). The data from the primary article[1] indicate that the rate of ICH was less than 1.0% in all groups. Similarly, the rate of major bleeding was 3.0% in the enoxaparin group versus 2.21% in the unfractionated heparin group.

Importantly, however, the safety results cited in the work by Mukherjee and Bates are derived from ASSENT-3 PLUS. This adjunct to the main trial primarily examined pre-hospital therapy for patients experiencing an acute infarction. However, it should be noted that ASSENT-3 PLUS was exploratory in nature, had a considerably smaller sample size, and the results were confounded by several variables, including marked differences in the manner and timing of antithrombin administration.

The results (n = 6095) from the primary article[1] better serve the readers’ efforts to understand and adjudicate the clinical utility of this trial.


Christopher O NesselM.D. 

Executive Director, Clinical Development, The Medicines Company

8 Campus Drive, Parsippany, NJ 07054