Clot-Busting Drugs: One Size Doesn't Fit All
May 15, 2000 -- Clot-busting drugs, which are currently used as the best
emergency treatment for heart attack patients, don't help patients over age 75
and may actually do harm. This is in dramatic contrast to the experience of
patients younger than 75. In the younger group, for every 100 patients treated
with clot busters, one life is saved.
"We confirmed in this very large, nationwide study that patients younger
than 75 years clearly do benefit from these drugs," says senior author Neil
R. Powe, MD, MPH, MBA. "However, our study raises concerns that
thrombolytic [clot-busting] therapy may not offer any benefit to older
patients, and, in fact, may do harm." Powe is professor of medicine,
epidemiology, health policy, and management at the Johns Hopkins University
School of Medicine in Baltimore.
The study, by a research team at Johns Hopkins University, looked at almost
8,000 Medicare patients aged 65 to 86 years who had heart attacks. Those under
75 receiving clot busters had a 6.8% death rate 30 days after the heart attack.
Nearly 10% of these patients died when they did not get the drugs. But in the
older patient group, those getting clot busters were 40% more likely to die
within 30 days of treatment.
While the research team did not gather data on causes for the increased
death rate, Powe speculates it may be due to medication side effects, such as
excessive bleeding or heart beat disturbances.
"This study offers an interesting analysis of what has happened over the
course of several years in patients" receiving clot-busting drugs, says
Thomas Davis, MD. "It has found what many of us in active practice believed
to be the case: that older patients may not do as well" on these drugs.
Davis is the medical director of the cardiac intensive care unit at St. John
Hospital in Detroit.
He believes physicians should take the results of this study very seriously,
particularly since now there are other options available for emergency
treatment. Sophisticated hospitals may be able to do an angioplasty, in which a
tiny balloon is used to open the blocked vessel in the heart. "In a
facility that doesn't offer angioplasty, [the physician should] consider using
other new medications," Davis says. "These medications could serve to
stabilize the patient for transfer to an institution that can do
Most importantly, patients should be aware that there are several options
and discuss the available choices with their doctor. "In the past, giving
heart attack patients a [clot-busting drug] within six hours was a knee-jerk
reaction," Davis says. "Now there are many other options. You should
ask your doctor if anything else could be done."
Davis and Powe agree that the major message from this study is that
physicians must look very carefully at all possible options for each specific
patient. "The big message here is: One size doesn't fit all," Powe
The study was funded by the Health Care Financing Administration, the Harry
and Jeanette Weinberg Foundation of Baltimore, and the Delmarva Foundation for
Medical Care in Easton, Md.