Angiox(R) (Bivalirudin) Alone Reduced Early Bleeding and Resulted in Similar One-Year Mortality Compared to Heparins Plus GP IIb/IIIa Combination Therapy in ACS Patients Undergoing Angioplasty



    Patients with acute coronary syndromes (ACS) undergoing
    percutaneous coronary intervention (PCI), or angioplasty, experienced
    nearly 50 percent less bleeding at 30 days and comparable mortality at
    one-year when treated with Angiox(R) (bivalirudin) alone compared to
    unfractionated heparin or enoxaparin plus a glycoprotein IIb/IIIa
    inhibitor (GPI), according to data from the ACUITY trial. These
    findings were consistent in patients switched to Angiox monotherapy
    from unfractionated heparin or enoxaparin. These data were presented
    today at the European Society of Cardiology (ESC) Congress 2007. The
    Medicines Company (NASDAQ: MDCO) recently re-acquired rights for
    Angiox in Europe and currently markets the product as Angiomax(R) in
    the United States.

    "The ACUITY trial demonstrated that Angiox is the preferred
    antithrombotic strategy in moderate and high risk ACS patients
    undergoing PCI. The subgroup analysis presented today gives us
    compelling new information on the benefits of switching ACS patients
    to Angiox," said lead author of the study, Harvey D. White, MD,
    Director of Coronary Care and Cardiovascular Research at Green
    Lane Cardiovascular Service, Auckland City Hospital, Auckland, New
    Zealand. "The reduction in early bleeding achieved with Angiox
    monotherapy is particularly important, as bleeding events are commonly
    linked to late mortality in these patients."

    The ESC recently published guidelines for the treatment of ACS
    that recommend using Angiox to replace heparins (unfractionated or
    low-molecular weight) and GPIs in ACS patients undergoing PCI.

    Study Details

    The subgroup analysis of the ACUITY trial in ACS patients
    undergoing PCI presented today are consistent with the overall ACUITY
    results. As previously reported, in ACS patients undergoing PCI, the
    risk of major bleeding at 30 days was significantly less - by nearly
    50 percent - in patients who received Angiox alone compared to those
    who received unfractionated heparin or enoxaparin plus GPI: 4% vs. 7%
    (p less than 0.0001).(1) In his presentation at ESC, Dr. White showed
    that the clinical benefits of Angiox monotherapy compared to
    unfractionated heparin or enoxaparin plus GPI were consistent across
    subgroups of patients, including those at high-risk, those who
    received other previous antithrombin therapy and were switched to
    Angiox, and those who did not receive prior antithrombin therapy.
    Additionally, the new analysis showed that, after one year, there were
    no significant differences in the incidence of composite ischemic
    events or mortality between patients who had received Angiox
    monotherapy and those who had received unfractionated heparin or
    enoxaparin plus GPI. The mortality results observed at one-year with
    Angiox monotherapy were not dependent on the timing of clopidogrel
    administration. PCI patients experiencing a non-CABG (coronary artery
    bypass graft) major bleed had a significantly longer length of
    hospital stay, 5.0 days vs. 3.0 days (p less than 0.0001), compared
    with those that did not bleed. Further, a strong association was
    observed between bleeding events at 30 days and one-year mortality in
    ACS patients undergoing PCI.

    About ACUITY

    ACUITY was one of the largest ACS clinical trials ever conducted
    to evaluate anti-thrombotic therapies and enrolled 13,819 high-risk
    patients in 450 centers worldwide. The trial design employed an early
    invasive strategy (angiography within 72 hours), starting
    anti-clotting therapy when ACS patients arrived at the emergency
    department and randomly assigning them to treatment with standard
    therapy of heparin (unfractionated or enoxaparin) plus GPI, Angiox
    plus GPI, or Angiox monotherapy. In the Angiox monotherapy group,
    selective use of GPI was permitted in limited circumstances and
    occurred in less than 10% of patients. Then, based on an evaluation in
    the cardiac catheterization laboratory, patients were treated for ACS
    through medical management, bypass surgery or PCI.

    About Angiox/Angiomax

    Angiox/Angiomax is currently approved in the European Union and
    the United States as well as several other territories. It is a direct
    thrombin inhibitor with a naturally reversible mechanism of action. In
    clinical trials, Angiox has demonstrated efficacy plus reductions in
    bleeding complications compared to heparin as the foundation
    anticoagulant in the contemporary catheterization lab setting. These
    reductions in bleeding complications remain evident even in high-risk
    patients.

    In the EU, Angiox is indicated for use as an anticoagulant in
    patients with unstable angina undergoing percutaneous transluminal
    coronary angioplasty (PTCA) and with provisional GPI in patients
    undergoing PCI. Angiox is also indicated in patients with, or at risk
    of, heparin-induced thrombocytopenia and thrombosis syndrome
    (HIT/HITTS) undergoing PCI. Angiox is intended for use with aspirin.
    The most common adverse events for Angiox in clinical trials comparing
    Angiox and heparin were back pain, pain, nausea, headache, and
    hypotension. The incidence of these adverse events was comparable in
    both the Angiox and heparin groups in these trials. An unexplained
    fall in blood pressure or hematocrit, or any unexplained symptom,
    should lead to serious consideration of a hemorrhagic event and
    cessation of Angiox administration. Angiox is contraindicated in
    patients with active major bleeding or hypersensitivity to Angiox or
    its components. Please see full prescribing information available at
    http://www.angiox.com.

    European regulatory authorities are currently reviewing an
    application for marketing authorization to expand the use of Angiox to
    include a proposed new dosage for immediate treatment of patients with
    acute coronary syndromes (ACS).

    MDCO-G

    About The Medicines Company

    The Medicines Company meets the demands of the world's most
    advanced medical practitioners by developing products that improve
    acute hospital care. The Company markets Angiomax(R) (bivalirudin) in
    the United States and other countries for use in patients undergoing
    coronary angioplasty, a procedure to clear restricted blood flow in
    arteries around the heart. In July 2007 the Company terminated its
    distribution arrangements with Nycomed and reacquired from Nycomed all
    development, commercial and distribution rights held by Nycomed for
    Angiox(R) (bivalirudin) in Europe. The Company also has two products
    in late-stage development, Cleviprex(TM) (clevidipine) and cangrelor.
    The Company's website is http://www.themedicinescompany.com.

    Statements contained in this press release about The Medicines
    Company and Angiomax(R)/Angiox(R) that are not purely historical, and
    all other statements that are not purely historical, may be deemed to
    be forward-looking statements for purposes of the safe harbor
    provisions under The Private Securities Litigation Reform Act of 1995.
    Without limiting the foregoing, the words "believes," "anticipates,"
    "expects," "estimates," "projects" and similar expressions are
    intended to identify forward-looking statements. These forward-looking
    statements involve known and unknown risks and uncertainties that may
    cause the Company's actual results, levels of activity, performance or
    achievements to be materially different from those expressed or
    implied by the forward-looking statements. Important factors that may
    cause or contribute to such differences include whether clinical trial
    results of the Company's product candidates will warrant submission of
    applications for regulatory approval on a timely basis or at all;
    whether the Company's product candidates will receive approvals from
    regulatory agencies on a timely basis or at all; and whether
    physicians will accept clinical trial results. Such factors and others
    are set forth in the risk factors detailed from time to time in the
    Company's periodic reports and registration statements filed with the
    Securities and Exchange Commission including, without limitation, the
    risk factors detailed in the Company's Quarterly Report on Form 10-Q
    filed on August 9, 2007, which are incorporated herein by reference.
    The Company specifically disclaims any obligation to update these
    forward-looking statements in the future. These forward-looking
    statements should not be relied upon as representing the Company's
    estimates or views as of any date subsequent to the date of this press
    release.

    (1) Stone GW, White HD, Ohman EM, Bertrand ME, Lincoff AM,
    McLaurin BT, Cox DA, Pocock SJ, Ware JH, Feit F, Colombo A, Manoukian
    SV, Lansky AJ, Mehran R, Moses JW; Acute Catheterization and Urgent
    Intervention Triage strategy (ACUITY) trial investigators. Bivalirudin
    in patients with acute coronary syndromes undergoing percutaneous
    coronary intervention: a subgroup analysis from the Acute
    Catheterization and Urgent Intervention Triage strategy (ACUITY)
    trial. Lancet. 2007 Mar 17;369(9565):907-19.