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One-Two Punch Breaks Up Clots and Prevents Second Heart Attack

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WebMD Health News

June 14, 2001 -- One of the biggest challenges in treating heart attack patients is figuring out how to prevent another one. Unfortunately, most heart attack treatments have been limited in this regard, until now.

New research in this week's issue of The Lancet suggests that giving heart attack patients two powerful drugs in the emergency room can lower the risk of having a second heart attack by 17%.

A heart attack occurs when the normal blood flow to the heart muscle is interrupted, usually by a blood clot. Thus, most heart attack victims receive a clot-busting drug in combination with other medicines and often eventually undergo a surgical procedure to keep the blood vessels open.

This newest strategy combines a widely available clot-busting drug, Retavase, with a drug called Reopro that targets platelets, a major component of blood clots. In the study more than 16,000 heart attack patients were treated with either Retavase alone or a half-dose of Retavase plus a full dose of Reopro.

The combination treatment reduced the risk of a second heart attack by 17%, says the study's author Eric J. Topol, MD. The combination of drugs did not, however, reduce death from the initial heart attack within 30 days. But he believes that when his team re-evaluates the patients after a year, there will be a significant decrease in the number of deaths among patients who received the combination therapy. "It does look very promising," Topol says.

This new drug combination appears to work best in those people with more severe heart attacks -- meaning that a larger area of the heart is affected -- and among those who are less than 70 years of age, says Topol.

Although Topol is very enthusiastic about the results, another expert, Steve Marso, MD, of MidAmerica Heart Institute and assistant professor at the University of Missouri in Kansas City, is not as impressed. He tells WebMD that the study was designed to show that the combination treatment saved lives and "the answer to that question is: no."

But Marso still thinks Topol may be on to something. He says the findings on second heart attacks suggest that this combination may buy precious time for heart attack sufferers who don't live near a large hospital where more aggressive heart attack treatments can be provided. Marso suggests that these patients will be given this new combination and then transported to other centers for additional treatment.

But the ultimate goal, says Marso may be triple therapy, in which the patient receives the combination therapy studied by Topol and then is whisked off to have his or her arteries propped opened using stents. "That is where we may really see a survival advantage," Marso says.

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