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Comparison of anticoagulants for angioplasty show similar outcomes
March 31, 2008In a comparison of anticoagulants and stents for use with angioplasty following a heart attack, the anticoagulants abciximab and tirofiban had similar outcomes for some cardiac measures within 90 minutes after the procedure, while patients who received stents that released the drug sirolimus had a lower risk of major adverse cardiac events within 8 months than patients who received uncoated stents, according to a JAMA study being released early online March 30 to coincide with its presentation at the annual conference of the American College of Cardiology. The study will be published in the April 16 issue of JAMA.
Infusion with abciximab and implantation of an uncoated-stent is a treatment strategy used to reduce major adverse cardiac events (MACE) in patients undergoing angioplasty (percutaneous coronary intervention [PCI]) for ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack). It is uncertain whether there may be similar benefits in replacing abciximab with tirofiban, which could have clinical and economical implications. Drug-releasing stents reduce the need for repeat subsequent procedures to open obstructed blood vessels after elective PCI compared with uncoated stents, however their use in this patient population is discouraged because of conflicting efficacy results and safety concerns.
Marco Valgimigli, M.D., Ph.D., of the Cardiovascular Institute, University of Ferrara, Italy, and colleagues evaluated the effect of high-dose tirofiban and sirolimus-releasing stents compared with abciximab infusion and uncoated-stent implantation in 745 patients with STEMI undergoing PCI. The trial was conducted in Italy, Spain, and Argentina between October 2004 and April 2007.
The researchers found that among the 722 patients (97 percent) who had an interpretable electrocardiogram, at least 50 percent resolution of ST-segment elevation on the electrocardiogram at 90 minutes following PCI occurred in 302 of 361 patients (83.6 percent) and 308 of 361 patients (85.3 percent) in the abciximab and tirofiban groups, respectively. Ischemic and hemorrhagic outcomes were similar in these groups.
At 8 months, the MACE rate was similar among those who received tirofiban (9.9 percent) and those who received abciximab (12.4 percent) but was higher among those who were treated with the uncoated stent (54 patients, 14.5 percent) compared with those who were treated with the sirolimus-releasing stent (29 patients, 7.8 percent). Revascularization (repeat procedure to unblock a blood vessel) was reduced from 10.2 percent with the uncoated stent to 3.2 percent with the sirolimus-releasing stent.
"In summary, our study provides evidence that in a broad population of largely unselected patients undergoing PCI for STEMI, tirofiban therapy is associated with a noninferior resolution from ST-segment elevation at 90 minutes postintervention compared with abciximab, and at 8-month follow-up, MACE are approximately halved by sirolimus-eluting stent implantation compared with uncoated stents," the authors write.
JAMA and Archives Journals
The researchers found that among the 722 patients (97 percent) who had an interpretable electrocardiogram, at least 50 percent resolution of ST-segment elevation on the electrocardiogram at 90 minutes following PCI occurred in 302 of 361 patients (83.6 percent) and 308 of 361 patients (85.3 percent) in the abciximab and tirofiban groups, respectively. Ischemic and hemorrhagic outcomes were similar in these groups.
At 8 months, the MACE rate was similar among those who received tirofiban (9.9 percent) and those who received abciximab (12.4 percent) but was higher among those who were treated with the uncoated stent (54 patients, 14.5 percent) compared with those who were treated with the sirolimus-releasing stent (29 patients, 7.8 percent). Revascularization (repeat procedure to unblock a blood vessel) was reduced from 10.2 percent with the uncoated stent to 3.2 percent with the sirolimus-releasing stent.
"In summary, our study provides evidence that in a broad population of largely unselected patients undergoing PCI for STEMI, tirofiban therapy is associated with a noninferior resolution from ST-segment elevation at 90 minutes postintervention compared with abciximab, and at 8-month follow-up, MACE are approximately halved by sirolimus-eluting stent implantation compared with uncoated stents," the authors write.
JAMA and Archives Journals
Anticoagulant Current Events and Anticoagulant News RSSWomen may stop anticoagulants after blood clots
Women may safely discontinue oral anticoagulants (blood thinners) after 6 months of treatment following a first unprovoked venous blood clot (thromboembolism) if they have no or one risk factor.
New blood clot guidelines for pregnant women
New evidence-based guidelines address the prevention and management of thrombosis in key patient populations and reinforce recommendations related to the routine use of preventive therapies.
Computers as safe as medical experts for prescribing blood thinning drugs
The largest ever study into the administration of blood thinning drugs, principally Warfarin, has concluded that dosages calculated by computer are at least as safe and reliable as those provided by expert medical professionals.
Findings released from 1 of the largest percutaneous coronary intervention trials ever
A study led by Gregg W. Stone, M.D., professor of medicine at Columbia University Medical Center/NewYork-Presbyterian and chairman of the Cardiovascular Research Foundation, has shown that heart attack patients who were administered the direct thrombin inhibitor bivalirudin during primary angioplasty had a reduced rate of adverse clinical events, a lower rate of major bleeding, and a lower mortality rate than those who were treated with a regimen of heparin and glycoprotein IIb/IIIa inhibitors (GPI).
Landmark study reveals superiority of bivalirudin in heart attack patients at 30 days
The Cardiovascular Research Foundation (CRF) announced today that the New England Journal of Medicine published results of the HORIZONS AMI trial which showed the use of the anticoagulant bivalirudin following angioplasty in heart attack patients reduced net adverse clinical events by 24 percent compared to the standard treatment, as well as reduced the risk of overall mortality by 33 percent and cardiac mortality by 38 percent.
Commencement 2008: Undergrad Has Sweet Success With Invention of Artificial Golgi
An undergraduate student at Rensselaer Polytechnic Institute has learned very quickly that a spoonful of sugar really does help the medicine go down. In fact, with his invention, the sugar may actually be the medicine.
Osteoporosis drug Fosamax linked to heart problem
omen who have used Fosamax are nearly twice as likely to develop the most common kind of chronically irregular heartbeat (atrial fibrillation) than are those who have never used it, according to research from Group Health and the University of Washington published in the April 28 Archives of Internal Medicine.
Clumps of red and white blood cells may contribute to sickle cell disease
It's long been known that patients with sickle cell disease have malformed, "sickle-shaped" red blood cells - which are normally disc-shaped - that can cause sudden painful episodes when they block small blood vessels.
Key Found to Breakthrough Drug for Clot Victims
A team of researchers at Oregon Health & Science University and Washington University in St. Louis have described for the first time the mechanism that gives a mutant enzyme molecule that they have engineered - and patented - the potential to become a breakthrough drug for treating heart attacks and strokes.
Potentially Safe and Effective Therapy Revealed for Patients with Protein-Losing Enteropathy
Researchers at the Burnham Institute for Medical Research (Burnham Institute) have developed the first model to study intestinal protein leakage in mice, allowing the team to control and replicate both genetic deficiencies and environmental damages in an in vivo setting.
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