ATOLL Study Results With Intravenous Enoxaparin in Acute Heart Attack Managed with Urgent Angioplasty

Composite Primary Endpoint: Risk Reduction of 17% (Non-Statistically Significant ) in Death, Complication of Myocardial Infraction, Procedure Failure or Major Bleeding (p=0.07)

PARIS, August 30, 2010 - Pitie-Salpetriere Hospital, Paris, France, August 30th 2010.
The international ATOLL study sponsored by the Assistance Publique - Hopitaux
de Paris showed that enoxaparin reduced the composite of death, complication
of myocardial infraction, procedure failure or major bleeding by 17% in
comparison with standard heparin (p=0.07) in acute heart-attack (STEMI)
patients managed with primary Percutaneous Coronary Intervention (PCI). The
pre-specified main secondary efficacy endpoint showed that treatment with
enoxaparin resulted in a statistically significant 40% reduction of patients'
death, recurrent acute coronary syndrome or urgent revascularisation. The
results of the ATOLL study were presented at the hotline session of the
annual European Cardiology Congress (ESC 2010) in Stockholm, Sweden.

As a result of acute heart attack (STEMI), overall one third
of patient may die in the first 24 hours after the onset of the ischemic
symptoms, making patients' access to appropriate care units critical. In real
life mortality remains high with up to a 10 % death rate at 30 days.

'With all the "hard" pre-specified ischemic and death related
endpoints favoring enoxaparin over UFH, enoxaparin becomes a new alternative
in primary PCI', said Prof. Gilles Montalescot, Head of Cardiac Care Unit
(CCU) at Pitie-Salpetriere Hospital in Paris and lead investigator of the
ATOLL study. 'By allowing maintenance of the same anticoagulant throughout
patient management from the emergency room or the ambulance to the
catheterization laboratory then to the Cardiac Care Unit, without
anticoagulation monitoring, enoxaparin is securing and simplifying the
treatment strategy' he added.

The international ATOLL study sponsored by the Assistance
Publique - Hopitaux de Paris enrolled 910 patients suffering from ST-elevated
Myocardial Infraction (STEMI), the most severe form of heart attack. Patients
received either intravenous administration of 0.5 mg/kg enoxaparin
(Clexane/Lovenox(R)) without anticoagulation monitoring/dose adjusted or
standard UFH (unfractionated heparin) prior to primary Percutaneous Coronary
Intervention, a procedure also referred as angioplasty and stenting.

With regard to major bleeding risk, the main safety endpoint,
no difference was observed in the two treatment groups (respectively 4.9% and
4.5% for UFH and enoxaparin). The same observation was reported with minor
bleeding risk (8.9% with UFH and 7% with enoxaparin).

About ATOLL

The ATOLL (Acute STEMI Treated with primary angioplasty and
intravenous enoxaparin Or UFH to Lower ischemic and bleeding events at short
and Long-term follow-up) study is the first randomised, head-to-head
comparison between unfractionated heparin (UFH) and Clexane/Lovenox(R)
(enoxaparin) in primary angioplasty in subjects with ST-segment elevation
myocardial infarction (STEMI). The ATOLL study included 910 subjects from 31
sites in several countries including Austria, France, Germany and the United
States. Patients were randomized within 24 hours of symptom onset to receive
either UFH IV bolus (ACT-adjusted), 50-70IU with concurrent GP IIb/IIIa
treatment or 70-100IU without GP IIb/IIIa treatment, or Clexane/Lovenox(R)
(enoxaparine) 0.50 mg/kg IV bolus without monitoring. The ATOLL study is
sponsored by AP-HP (Assistance Publique-Hopitaux de Paris) and received
funding from AP-HP, in addition to an unrestricted research grant from
sanofi-aventis.

About ST-elevation-myocardial infarction (STEMI)

STEMI is one of the most serious and one of the most deadly
types of heart attacks characterized by an abrupt, complete blockage of a
coronary artery. It leads to irreversible myocardial damage as a result of
insufficient blood supply to the heart muscle (or myocardial ischemia). STEMI
is usually recognized by an elevation of the ST segment on the ECG,
indicating that a large amount of heart muscle damage is occurring.

About primary Percutaneous Coronary Intervention (PCI)

Primary PCI, often referred to as primary angioplasty,
involves opening the artery using a small balloon to clear the blockage.
During the procedure, a catheter is threaded through an artery up through the
blood vessel to the area in the coronary artery that is blocked. A small
balloon at the tip of the catheter is inflated to widen the blood vessel and
restore blood flow to the heart. Often a small metal mesh tube called a stent
is placed in the artery to keep it open.

Salah Mahyaoui, +33-6-73-68-78-88