Giving a high dose of the anti-clotting drug tirofiban to heart attack victims while on route to the hospital could improve their chances of survival, a new report says.
The study, published in a special cardiology issue ofThe Lancetthis week, showed that patients given tirofiban in addition to the standard triple treatment of the anti-clotting agents aspirin, heparin and clopidogrel had significant less blockage affecting their heart than those given only the three standard medicines and a placebo.
The researchers -- lead by Arnoud van't Hof, Isala Klinieken of the department of cardiology, Zwolle, Netherlands -- found that major bleeding did not differ significantly between the two groups (4 percent of patients in the tirofiban group and 3 percent in standard group).
"Our trial was not powered on a difference in clinical outcome between the two groups. However, we noted a better clinical outcome in the tirofiban group than in the placebo group, with lower overall mortality and less urgent repeat [primary coronary angioplasty]," the authors wrote.
In an accompanying comment, Gilles Montalescot of the Institute of Cardiology Piti-Salptrire Hospital, INSERM 856 and University of Paris 6, Paris, wrote that the study "reveals that high-dose clopidogrel is not effective enough and confirms the need for fast and strong platelet inhibition. It reminds us also that the first contact with the patient must be rapid and medical. Until now, only well-organized hospital systems have been able to provide such a service."
The special issue ofThe Lancetalso features an article about a study that says while a combination therapy of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) reduces more excess protein in the urine (proteinuria) than either therapy alone in patients at high vascular risk, it could also result in greater kidney damage.
Proteinuria can be a sign of kidney damage, as malfunctioning kidneys allow proteins into the urine. Diabetes is the most common cause of proteinuria, although a range of other conditions can cause it.
An accompanying comment by doctors from University of Thessaloniki in Greece and the University of Chicago concluded "these data should not lead to guideline modifications ... Combined with previous studies, [this study] supports the notion that use of single agents to block the renin-angiotensin system is well-tolerated."
More information
The U.S. Heart, Blood, and Lung Institute has more about current heart attack treatments.
SOURCE:The Lancet, news release, Aug. 14, 2008
