Clot Busters Before Angioplasty Linked to Increased Death Risk

Giving clot-busters to heart attack victims who are scheduled for balloon angioplasty could cost them their lives, new research shows.

In a study of more than 1,600 people, those who were given a clot-busting drug before angioplasty were nearly 40 percent more likely to die in the next month than those who got angioplasty alone.

The study, presented Tuesday at the annual meeting of the European Society of Cardiology, showed that 6 percent who were given the clot-buster TNKase before angioplasty died vs. 4 percent who got angioplasty alone.

The trial was halted early due to the surprising excess death rate in patients given the clot-buster, says Frans Van de Werf, MD, chairman of the cardiology department of the University Hospital Gasthuisberg in Leuven, Belgium.

”We’re not sure what is going on,” he tells WebMD. “Could we have unwittingly sent the people in the [clot-buster] group to more experienced doctors or more experienced hospitals? We just don’t know.”

What Happens During a Heart Attack

Message Is ‘Clear’

De Werf says he hopes that final study results, scheduled to be released in November at the annual meeting of the American Heart Association, will help shed more light on the issue.

Raymond Gibbons, MD, professor of cardiology at the Mayo Clinic in Rochester, Minn., tells WebMD that the findings are clear: Doctors who are giving clot-busters to heart attack victims scheduled for angioplasty in the next few hours should stop using the drugs. People in the study got angioplasty one to three hours after symptoms began.

At the same time, Gibbons stresses, there is still a huge role for clot-busters in treating heart attack victims.

Though angioplasty is considered a better option if it is performed by experienced doctors at well-equipped hospitals, most rural and community hospitals do not have such expertise, he explains.

In such cases, clot-busters are lifesaving.

“Right now, one in four heart attack victims who are candidates for clot-busters or angioplasty get neither one,” he says. “If you think you are having a heart attack, call 911 – immediately.”

Hope for the Heart: Treatment Advances

By Charlene Laino, reviewed by Michael W. Smith, MD

SOURCES: European Society of Cardiology Congress 2005, Stockholm, Sweden, Sept. 4-7, 2005. Frans Van de Werf, MD, chairman, cardiology department, University Hospital Gasthuisberg, Leuven, Belgium. Raymond Gibbons, MD, professor of cardiology, Mayo Clinic, Rochester, Minn.; president-elect, American Heart Association.