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Pairing Two Drugs with Angioplasty may Offer Best Success

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Duke Health News 919-660-1306

DALLAS, TX -- Combining a "super aspirin" with bursts of a clot-busting
drug during an angioplasty for patients experiencing a heart attack could
offer the best strategy to quickly and safely open clogged arteries, Duke
University researchers said at the annual American Heart Association
scientific sessions.

Results of a dose-ranging trial show that using abciximab and two
low-dose boluses of reteplase 30 minutes apart provided complete blood flow
to up to 35 percent more patients than using abciximab alone or abciximab
and a single dose of reteplase.

If the findings are confirmed and expanded in a larger clinical trial,
pairing the drugs with angioplasty may offer a new standard of care for
heart attacks, said the trial leader, Dr. Magnus Ohman, a cardiologist at
the Duke Clinical Research Institute.

"Most patients now receive either a clot-busting drug or angioplasty to
treat their heart attacks. Combining both together, and adding a second
'super-aspirin' drug appears to offer a very high success rate and may
represent an exciting new step in treating most heart attacks," Ohman
said.

He added that previous studies have shown that using a clot-busting drug
alone is significantly less effective in restoring full blood flow (46
percent of patients), compared with using the right dose of a clot-buster
and a "super aspirin" (63 percent of patients in this study had full blood
flow after an hour).

Abciximab, known under the trade name Reopro, has been dubbed the
ultimate aspirin because it stops blood from clotting, and reteplase, known
as r-PA, dissolves blood clots. Both drugs are federally approved and on the
market.

The Phase II dose-ranging trial, known as SPEED (Strategies for Patency
Enhancement in the Emergency Department) was undertaken to find the fastest
and safest way to open clogged arteries in a patient experiencing a heart
attack. It was conducted in 61 hospitals with 305 patients from the U.S.,
Germany, Italy, Spain and Australia. SPEED was funded by Centocor and Eli
Lilly, manufacturers of abciximab and reteplase.

SPEED is the first trial to test the use of both drugs with angioplasty,
a procedure that presses plaque obstructions against an artery wall by
inflating a small balloon from a catheter. Of the 305 patients tested, up to
80 percent had angioplasties, and of this group, another 80 percent received
a stent.

It was also unique in that it enrolled patients within 60 minutes of
being seen in an emergency department, instead of the standard 90 minutes,
Ohman said. "That's because 60 minutes is within the time span most patients
are sent for a primary angioplasty."

Patients considered for the trial were those suffering uncomplicated
heart attack, and whose symptoms lasted less than six hours. Those patients
who had a prior history of stroke, bleeding, and heart surgery, among other
factors, were not included.

Using abciximab (a bolus 0.25 mg/kg; infusion 0.125 micrograms/kg/min)
alone or with reteplase, the researchers found that after 60 minutes:

63 percent of patients given abciximab with two low-dose (5 unit) boluses
of reteplase 30 minutes apart had full blood flow.

One low dose (5U) bolus of reteplase with abciximab gave 53 percent of
patients restored blood flow.

Adding r-PA to the regimen resulted in no increased bleeding.

Only 28 percent of patients given abciximab alone had restored blood
flow.

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