New combination therapy could reduce Ischaemia after heart attack

August 23, 2001

N.B. Please note that if you are outside North America the embargo for Lancet press material is 0001hours UK time Friday 24th August 2001.

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."
-end-
Contact: Professor Frans Van de Werf,Department of Cardiology, Gasthuisberg University Hospital, Herestraat 49, Leuven, B-3000, Belgium; T) 32-16-34-34-72; F) 32-16-34-34-67, E) Frans.VandeWerf@uz.kuleuven.ac.be.

Lancet

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.