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New Combination Therapy Could Reduce Ischaemia After Heart Attack (p 605)
August 22, 2001Encouraging results from a fast-track study published in this week's issue of THE LANCET suggest a new therapeutic strategy for reducing ischaemic complications (coronary artery blockage) after heart attack.
The treatment of acute heart attack requires combination of several therapies. Fibrinolytic agents given together with aspirin and unfractionated heparin often fail to restore coronary artery bloodflow. Frans Van de Werf and colleagues from Gasthuisberg University, Leuven, Belgium, did an exploratory trial to identify whether specific combinations with newer antithrombotic agents might provide clinical benefit. The aim of the study was to compare the efficacy and safety of three antithrombotic therapies with the fibrinolytic agent tenecteplase.
6095 patients (from 575 hospitals in 26 countries) with acute heart attack of less than six hours were randomly assigned one of three combinations: full-dose tenecteplase and enoxaparin (a low-molecular-weight heparin) for a maximum of 7 days (enoxaparin group); half-dose tenecteplase with weight-adjusted low-dose unfractionated heparin and a 12-hour infusion of abciximab ,a glycoprotein IIb/IIIa inhibitor of platelet aggregation,(abciximab group); or full-dose tenecteplase with weight-adjusted unfractionated heparin for 48 hours(unfractionated heparin reference group.) The primary endpoints were the composites of death within 30 days, recurrence of heart attack in hospital, or ischaemia in hospital. A further endpoint of intracranial bleeding or other bleeding complications was added to assess therapeutic safety.
There were significantly fewer endpoints in the enoxaparin and abciximab groups than in the unfractionated heparin group (11.4% and 11.1% compared with 15.4%); Similar differences between groups were found when the combined efficacy plus safety outcome was assessed (13.7% and 14.2% compared with 17%)
Frans Van de Werf comments: "The tenecteplase plus enoxaparin or abciximab regimens studied here reduce the frequency of ischaemic complications of an acute heart attack. Taking into account efficacy and safety, the combination of full-dose tenecteplase and prolonged subcutaneous administration of enoxaparin emerged as the best treatment in this trial. Because of additional advantages such as the ease of administration and the lack of need for monitoring of anticoagulation, this combination should be regarded as an attractive alternative pharmacological reperfusion strategy deserving further study."
Lancet
There were significantly fewer endpoints in the enoxaparin and abciximab groups than in the unfractionated heparin group (11.4% and 11.1% compared with 15.4%); Similar differences between groups were found when the combined efficacy plus safety outcome was assessed (13.7% and 14.2% compared with 17%)
Frans Van de Werf comments: "The tenecteplase plus enoxaparin or abciximab regimens studied here reduce the frequency of ischaemic complications of an acute heart attack. Taking into account efficacy and safety, the combination of full-dose tenecteplase and prolonged subcutaneous administration of enoxaparin emerged as the best treatment in this trial. Because of additional advantages such as the ease of administration and the lack of need for monitoring of anticoagulation, this combination should be regarded as an attractive alternative pharmacological reperfusion strategy deserving further study."
Lancet
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Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
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Heart and bone damage from low vitamin D tied to declines in sex hormones
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Early end to key study on benefits of niacin, a B vitamin, in keeping arteries open was premature
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oo much selenium can increase your cholesterol
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Higher carotid arterial stenting rates associated with poorer clinical outcomes
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Study suggests dentists can identify patients at risk for fatal cardiovascular event
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