WEDNESDAY, May 21 (HealthDay News) -- Emergency treatment with two different anti-clotting drugs doesn't help much when someone who suffers a heart attack can't get a quick artery-opening procedure, new research shows.
On a brighter note, a third anti-clotting agent does improve results of such a procedure after a heart attack, another study finds.
Both studies, reported in the May 22 issue of the New England Journal of Medicine, are important for the 1.2 million Americans who have heart attacks each year. They are supposed to get what used to be called angioplasty and now goes by the formal medical name of percutaneous coronary intervention (PCI), in which a balloon-tipped catheter is threaded into a blocked artery, preferably within three hours of the attack.
That goal is hard to achieve in many cases, often because a hospital equipped for PCI isn't close enough. So cardiologists have been testing the value of two drugs -- reteplase, which dissolves clots, and abciximab, which prevents their formation -- for people who don't get PCI within the recommended time frame.
However, a study of 2,452 people whose treatment started as late as six hours after a heart attack found no value from the drug treatment.
Some people were given abciximab and reteplase well before PCI, some were given early abciximab, and some were given abciximab just before PCI. The incidence of major problems and death was about the same for all three methods -- 9.8 percent, 10.5 percent and 10.7 percent, respectively.
"Combination therapy, when given up front, did not offer any benefit in the primary endpoints of the study," said Dr. Jane A. Leopold, an assistant professor of medicine at Harvard Medical School, who wrote an accompanying editorial. "In fact, it led to an increase in bleeding. This study tells us that by giving these drugs to patients up front, we are not helping them."
The report probably will affect medical practice, Leopold indicated. "A number of interventional cardiologists have been awaiting results of this trial, because it was a definitive study of combination-facilitated PCI," she said.
