Reduced risk of recurrent heart attack with anticoagulant drug

November 29, 2001

N.B. Please note that if you are outside North America the embargo for Lancet Press material is 0001 hours UK Time Friday 30th November 2001

Results 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."
Contact: Professor Harvey D White, Cardiology Department, Green Lane Hospital, Private Bag 92 189, Auckland 1030, New Zealand; T) +64 9 630 9992; F) +64 9 630 9915; E)


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