Drug Combo Reduces Second Heart Attack Risk

The results of a large, international multicenter study (GUSTO V) show that combining a clot-dissolving drug with a drug that targets platelets reduced the risk of a second heart attack in heart patients by 17%. The study, overseen by the Cleveland Clinic (OH, USA), was published in the June 16, 2001, issue of The Lancet.

The study was conducted in 820 hospitals in 20 countries and involved 16,588 patients. The trial compared the results of standard clot-dissolving therapy (reteplase) with a new regimen combining reteplase with abciximab, a drug directed against platelets. All patients also received aspirin and heparin, a blood thinner. At 30 days, the death rate was equivalent for the two separate strategies, but the combination therapy produced a reduction (7.4% versus 8.8%) in second heart attack risk. The combination therapy also improved 14 of the 16 major complications of a heart attack. The disadvantage of the combination therapy was that it led to an increased risk of bleeding complications, although they were not life-threatening or permanent.

Since 1987, clot-dissolving agents such as t-PA (tissue plasminogen activator), streptokinase, and reteplase have been the treatment of choice for patients presenting with a heart attack within six hours from the onset of symptoms. Until recently, 2b/3a inhibitors such as abciximab were shown to be highly effective in stenting and balloon angioplasty procedures but their value in heart attack was not established.

"This represents a key, incremental advance that might not be applicable to all patients with heart attack,” noted Eric J. Topol, M.D., GUSTO chairman and chairman of the department of cardiology at The Cleveland Clinic. "But this looks like a big step forward for patients who are younger than age 75 and who have a moderate to large threatened heart attack.”





Related Links:
Cleveland Clinic
The Lancet