Nav: Home

No advantage of ambulance over hospital anti-clot therapy (SCAAR)

August 29, 2017

Barcelona, Spain - 29 Aug 2017: In contrast to European and American guidelines that recommend pre-hospital antiplatelet therapy for heart attack patients suffering from ST-elevation myocardial infarction (STEMI), a new study presented at ESC Congress1 suggests this practice has no advantage over waiting for in-hospital treatment.

"Pre-hospital administration is common practice - despite the lack of definite evidence for its benefit," said study investigator Dr Elmir Omerovic, PhD, from Sahlgrenska University Hospital, Gothenburg, Sweden.

"But our study - which is the largest cohort study conducted so far - adds to some previous evidence suggesting there is potential for harm. In fact, inadvertent prehospital administration of these drugs to patients with contraindications to antithrombotic therapy is common. Therefore, considering all current evidence, we think pre-hospital administration should be discouraged."

The retrospective study used data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) to identify 44,804 STEMI patients undergoing percutaneous coronary intervention (PCI) - a revascularisation procedure - between 2005 and 2016.

Most of the patients were pre-treated with antiplatelet therapy, but 6,964 were not.

Comparing pre-treated patients to those not pre-treated, the investigators found no significant benefits of pre-treatment in terms of 30-day mortality (odds ratio 0.91; P=0.36), or other endpoints including measures of arterial blockage, cardiogenic shock, neurological complications, or bleeding complications.

The ESC, as well as the American College of Cardiology and American Heart Association recommend pre-hospital antiplatelet treatment, but the current study adds to growing evidence that may tip the pendulum.

The ATLANTIC trial, presented at ESC Congress a few years ago gave the first hint that pre-treatment might offer no advantages, but it was a study with relatively short delays for patients receiving in-hospital treatment, explained Dr. Omerovic.

"Our new data addresses some of the concerns with ATLANTIC and offers stronger evidence that pre-treatment is not necessary," he said. "We hope the accumulated evidence will be convincing enough to discourage this practice and trigger a change in recommendations."
-end-


European Society of Cardiology

Related Antiplatelet Therapy Articles:

Genetic testing for antiplatelet therapy post-PCI misses cut in cardiovascular events
An international clinical trial that used genetic testing to guide which antiplatelet medication was given to patients following percutaneous coronary intervention (PCI) did not meet its stated goal for cutting in half the incidence of serious adverse cardiovascular events, such as heart attack and stroke, in the year following the procedure, according to study results presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).
Antiplatelet drugs increase risk for TAVR patients with atrial fibrillation
Patients with atrial fibrillation who took oral anticoagulants alone after undergoing transcatheter aortic valve replacement (TAVR) had a lower rate of bleeding complications without an increased risk of clotting-related complications compared to patients who took antiplatelet medication in addition to oral anticoagulants, in a trial presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).
Dual therapy reduces risk for bleeding better than triple therapy for patients with atrial fibrillation
Use of dual therapy with a direct oral anticoagulant (DOAC) plus P2Y12 inhibitor was associated with reduced risk for major bleeding compared with triple therapy with a vitamin K antagonist (VKA) plus aspirin and P2Y12 inhibitor for patients with nonvalvular atrial fibrillation after percutaneous coronary intervention (PCI).
Light therapy for immune cells helps with side effects of cancer therapy
A frequent side effect of cancer immunotherapies can probably be stopped by light activation of immune cells, as researchers at the Medical Center -- University of Freiburg have shown.
A new old therapy
The fight against drug-resistant pathogens remains an intense one. While the Centers for Disease Control's (CDC) 2019 'biggest threats' report reveals an overall decrease in drug-resistant microbe-related deaths as compared to its previous report (2013) the agency also cautions that new forms of drug-resistant pathogens are still emerging.
Study analyzes outcomes of dual antiplatelet therapy after minor stroke or TIA
An analysis of combined patient-level data from two randomized clinical trials  examined outcomes of dual antiplatelet therapy with clopidogrel and aspirin after minor stroke or transient ischemic attack.
'Seeing the light' behind radiation therapy
Delivering just the right dose of radiation for cancer patients is a delicate balance in their treatment regime.
Experimental antiplatelet compound for acute stroke shows promise
An experimental compound inhibited clot formation without increased bleeding, a common side effect of current anticlotting therapies, in a phase I study.
Researchers develop reversible antiplatelet therapy to fight clotting, cancer metastasis
A new reversible, drug-free antiplatelet therapy could reduce the risk of blood clots and potentially prevent cancer metastasis, according to a study published today in Science Translational Medicine.
Cilostazol-combo antiplatelet therapy reduced risk for recurrent stroke
The long-term combination of cilostazol with aspirin or clopidogrel resulted in fewer recurrent strokes than with aspirin or clopidogrel alone in high-risk patients.
More Antiplatelet Therapy News and Antiplatelet Therapy Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Clint Smith
The killing of George Floyd by a police officer has sparked massive protests nationwide. This hour, writer and scholar Clint Smith reflects on this moment, through conversation, letters, and poetry.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.