BLOOD-THINNING DRUG FOUND USEFUL BEFORE ANGIOPLASTY

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Heart-attack patients about to undergo balloon angioplasty may benefit from receiving the blood-thinning drug heparin while they await surgery, investigators report.

The drug may even eliminate the need for surgery in some patients, they suggested.

While angioplasty—in which a balloon is inflated to widen heart arteries that have been narrowed by fatty plaque—is highly effective in opening blocked arteries, the procedure is usually perform ed at least one hour after the patient arrives at the hospital, the study authors said.

During that "very crucial hour," nothing is being done to effectively speed up blood flow to the heart and prevent further damage to heart muscle s, said lead author Dr. Freek W. A. Verheugt, a cardiologist at the University Hospital in Nijmegen, the Netherlands.

But in the study of 108 heart-attack patients who were awaiting angioplasty, 51 percent had open vessels 90 minutes after being treated with heparin and aspirin.

By comparison, only 18 percent of 108 patients from another study who received standard therapy—aspirin and nitroglycerin, which helps widen arteries—had open vessels, Verheugt and colleagues said.

The new findings were reported in the February issue of the Journal of the American College of Cardiology.

"Ideally, we would like to do something that might speed up the natural return of blood flow in that [first] hour. That's why we tried this mega-dose of heparin," Verheugt said in a statement.

"If we can safely open up vessels with a drug like heparin, which is compatible with angioplasty, then we may be able to forgo angioplasty in some patients," he said. "And that will save a lot of money and the physical toll on the patient." ;

This study "is the first step towards saying we can make patients better if we start with heparin," said Dr. Morton J. Kern, director of the J. G. Mudd Cardiac Catheterization Laboratory at St. Louis Medical Center in St. Louis.

The study "is consistent with the idea that if you can open arteries before angioplasty, patients might do better," he said.

The St. Louis cardiologist explained that while balloon angioplasty has a high success rate, patient outcomes might be even better if heparin can help open more vessels in the hour before surgery.

"This is a unique study that no one has looked at before," said Dr. Richard Becker, director of the coronary care unit and the thrombosis research center at the University of Massachusetts in Worcester.

But though "these results are interesting and somewhat provocative, we need to do a larger scale study before anybody could or should consider this strategy," Becker said.

Journal of the American College of Cardiology (1998;31:289-93)

Publication Date : 1998-01-31

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