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Reduced Risk Of Recurrent Heart Attack With Anticoagulant Drug
November 28, 2001Results of a study in this week's issue of THE LANCET show that patients given the anticoagulant drug, bivalirudin, had a reduced risk of recurrent heart attack compared with patients given conventional treatment with heparin.
The combination of anticoagulant therapies (fibrinolytic therapy and the use of unfractionated heparin) for acute heart attack fails to achieve reperfusion (restoration of coronary blood flow) in 40-70% of patients. Harvey White from Green Lane Hospital, Auckland, New Zealand, and colleagues did a randomised trial to compare the thrombin-specific anticoagulant, bivalirudin, with heparin in patients undergoing fibrinolysis with streptokinase for acute heart attack.
Around 17,000 patients from 46 countries, with a specific heart-attack profile (acute ST-elevation myocardial infarction), were randomly assigned an intravenous bolus and 48-hour infusion of either bivalirudin or heparin, together with a standard 1.5 million unit dose of streptokinase (the most commonly used fibrinolytic agent worldwide). The primary endpoint was death within 30 days; secondary endpoints included recurrence of heart attack and bleeding.
Death rates at 30 days were similar in both groups (919 patients (10.8%) in the bivalirudin group and 931 (10.9%) in the heparin group). The risk of recurrent heart attack within four days (reinfarction) was reduced by 30% in the bivalirudin group compared with the heparin group. There was no significant increase in severe bleeding or intracerebral bleeding in patients given bivalirudin.
Harvey White comments: "Thrombin-specific anticoagulation with bivalirudin provides advantages over the use of unfractionated heparin. The clinical benefit/risk relation for bivalirudin versus heparin has shown a reduced risk of reinfarction and suggests a lower risk of the combined outcome of death, non-fatal reinfarction, or non-fatal disabling stroke at the cost of a relatively small increase in moderate bleeding. Bivalirudin should be considered as a new anticoagulant treatment option in patients with acute myocardial infarction treated with streptokinase."
Lancet
Death rates at 30 days were similar in both groups (919 patients (10.8%) in the bivalirudin group and 931 (10.9%) in the heparin group). The risk of recurrent heart attack within four days (reinfarction) was reduced by 30% in the bivalirudin group compared with the heparin group. There was no significant increase in severe bleeding or intracerebral bleeding in patients given bivalirudin.
Harvey White comments: "Thrombin-specific anticoagulation with bivalirudin provides advantages over the use of unfractionated heparin. The clinical benefit/risk relation for bivalirudin versus heparin has shown a reduced risk of reinfarction and suggests a lower risk of the combined outcome of death, non-fatal reinfarction, or non-fatal disabling stroke at the cost of a relatively small increase in moderate bleeding. Bivalirudin should be considered as a new anticoagulant treatment option in patients with acute myocardial infarction treated with streptokinase."
Lancet
Heart Attack Current Events and Heart Attack News RSSInhibition of GRK2 is protective against acute cardiac stress injuries
Inhibition of a protein known to contribute to heart failure also appears to be protective of the heart in more acute cardiac stress injury, namely ischemia reperfusion.
Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.
Heart and bone damage from low vitamin D tied to declines in sex hormones
Researchers at Johns Hopkins are reporting what is believed to be the first conclusive evidence in men that the long-term ill effects of vitamin D deficiency are amplified by lower levels of the key sex hormone estrogen, but not testosterone.
Elevated biomarkers lead to diminished quality of life in heart attack patients post-discharge
Many heart attack patients have high levels of cardiac biomarkers in the blood for several months after leaving the hospital, with more shortness of breath and chest pain, according to a Henry Ford Hospital study.
Tiny particles can deliver antioxidant enzyme to injured heart cells
Researchers at Emory University and the Georgia Institute of Technology have developed microscopic polymer beads that can deliver an antioxidant enzyme made naturally by the body into the heart.
Early end to key study on benefits of niacin, a B vitamin, in keeping arteries open was premature
Heart experts at Johns Hopkins are calling premature the early halt of a study by researchers at Walter Reed Army Medical Center and Washington Hospital Center on the benefits of combining extended-release niacin, a B vitamin, with cholesterol-lowering statin medications to prevent blood vessel narrowing.
oo much selenium can increase your cholesterol
A new study from the University of Warwick has discovered taking too much of the essential mineral selenium in your diet can increase your cholesterol by almost 10%.
Higher carotid arterial stenting rates associated with poorer clinical outcomes
Among eligible Medicare beneficiaries, increased use of carotid arterial stenting (CAS) procedures to treat carotid stenosis-the narrowing of the carotid artery-is associated with higher rates of mortality and adverse clinical outcomes, including heart attack and stroke, according to researchers from the University of Pennsylvania School of Medicine.
Study suggests dentists can identify patients at risk for fatal cardiovascular event
A new study indicates dentists can play a potentially life-saving role in health care by identifying patients at risk of fatal heart attacks and referring them to physicians for further evaluation.
Common Pain Relievers May Dilute Power of Flu Shots
With flu vaccination season in full swing, research from the University of Rochester Medical Center cautions that use of many common pain killers - Advil, Tylenol, aspirin - at the time of injection may blunt the effect of the shot and have a negative effect on the immune system.
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