New Findings on Cardiac Pretreatment

A new study suggests that facilitated angioplasty--the use of anticlotting drugs in heart-attack victims before angioplasty--is not only ineffective but also can lead to more deaths and serious complications than angioplasty alone.

An article published in the February 2006 edition of the Lancet challenged the underlying principle of facilitated angioplasty. Researchers from the University of Texas Southwestern Medical Center (Dallas, USA) analyzed 17 clinical trials that compared facilitated angioplasty with angioplasty alone. Many of those clinical trials already suggested that the combination was worse, but because the studies were relatively small the individual results had been viewed as inconclusive. The pooled analysis, which involved more than 4,500 patients, examined two kinds of drugs commonly used in facilitated angioplasty: the so-called IIb/IIIa inhibitors, which prevent blood-clot formation, and thrombolytics, which dissolve existing blood clots.

Using the drugs within hours of angioplasty led to more deaths, more subsequent heart attacks, more episodes of major bleeding, and more strokes than angioplasty by itself, the analysis found. The differences were statistically significant. The IIb/IIIa inhibitors did not offer any benefit over angioplasty alone, although they were not associated with harm. The thrombolytics, on the other hand, were associated with all the major adverse events.

In an accompanying editorial, Dr. Gregg Stone, a cardiologist from Columbia University Medical Center (New York, NY, USA) called the study's results unequivocal and said that, in hindsight, they are not so surprising since the drugs increased the risk of bleeding, among other side effects. This initial bleeding could be exacerbated by a subsequent angioplasty procedure. It's a bad combination, he said. Dr. Stone advised that studies should now be done to find out whether, if faced with a much longer delay before angioplasty can be performed, the drugs might still be helpful.



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University of Texas Southwestern Medical Center