Blood Thinner Improves Survival for Diabetics Receiving Stents
Dec. 20, 1999 (Urbana, Ill.) -- A single dose of a blood-thinning drug can significantly improve the odds of survival for diabetics who undergo procedures to unblock their coronary arteries.
The results, which appear in the Dec. 20 issue of the journal Circulation: Journal of the American Heart Association, could give physicians the green light to attempt an artery-opening procedure called stenting on diabetics who also suffer from coronary disease. Stenting involves a surgeon placing a small metal cylinder permanently inside a clogged coronary artery, which supplies blood to the heart muscle. Clogged coronary arteries can lead to heart attacks.
Two-thirds of diabetics have heart or blood vessel disease -- a rate so high that diabetes is considered one of the major risk factors for coronary artery disease, along with smoking, high blood pressure, and a family history of the disease.
In recent years, physicians had chosen to perform bypass surgery on diabetics rather than conduct stenting and another artery-opening procedure called balloon angioplasty. That's because several studies had shown that, compared to nondiabetics, diabetics face an increased risk of heart attack and clogged arteries after angioplasty, and researchers worried that the same would be true of stenting.
But drug researchers had also been working to overcome this problem. They thought that blood-thinning drugs, similar to aspirin but more powerful, could reduce the risk of clogged coronary arteries and thereby reduce the risk of heart attacks. Such drugs keep blood cells called platelets from clumping and forming blood clots, which can block blood flow to the heart and cause a heart attack.
Researchers at several medical centers combined efforts to test the effect of one promising blood-thinning drug, Reopro (abciximab), in both diabetic and nondiabetic patients. The study, called the EPISTENT trial, was designed to see whether the drug could improve the outcome in patients who undergo stenting. Earlier results from the study showed that the drug helped prevent blood clots in nondiabetic patients who received stents, but did not prevent their arteries from clogging gradually with cholesterol plaque over a period of months.