Super aspirin makes a debut

For those suffering with heart diseases, scientists just found drugs that are more effective than aspirin

Published: Monday 31 May 1999

-- (Credit: BAYER AG) aspirin -- 'the wonderdrug' of the 20th century -- has been said to cure or prevent everything from headaches to heart attacks. March 1999 marks the 100th anniversary of the launch of aspirin. Simple to make and easy to administer, aspirin is one of only a handful of brands to have transcended cultures, borders and generations to enjoy almost universal recognition. Initially sold in the form of powder, aspirin also was the first drug to be sold as a tablet.

Over the years, the medical applications of aspirin have multiplied. From its inception, it has been used against inflammation and to relieve pain and fever, but it was only recently that scientists discovered its effectiveness in helping prevent cardiovascular diseases, colorectal cancer and strokes. In the uk , doctors have found that taking a soluble aspirin within a few hours of suffering chest pain can prevent the onset of a heart attack and have urged everyone to carry the drug.

With the advent of new knowledge and technology, perhaps it is time for aspirin to make way for more potent drugs. Individuals treated with a particular type of blood-thinning drug have a 30 per cent less risk of dying within four days, according to a study conducted on more than 30,000 heart patients ( Circulation , Vol 98, No 25).

The drugs, part of a class called glycoprotein 2b 3a receptor blockers, could open a whole area for treating heart patients, or those at a risk of heart disease. The drugs keep blood platelets from clumping and forming blood clots that can trigger a heart attack or stroke.

Currently, the standard long-term therapy for such patients is the common aspirin or heparin, both of which inhibit the formation of blood clots. However, these platelet blockers -- sometimes called 'super aspirins' and sold under the generic names of eptifibatide, tirofiban and abciximab -- are more potent than aspirin. They are also administered through an intravenous drip.

"Aspirin is valuable for treating people with heart attacks and unstable angina -- severe chest pain that is often a sign of impending heart attack. This new family of drugs works harder at making platelets less sticky, and they do it to a far greater degree than many other blood-thinners we have tried in the past," says the study's lead author David F Kong of the Duke Clinical Research Institute in Durham, North Carolina, usa .

The study, conducted by researchers of Duke, the Cleveland Clinic Foundation and the Green Lane Hospital in Auckland, New Zealand, analysed 16 studies of about 32,000 heart attack patients. Participants received the platelet blocker drugs as part of their treatment for either heart attack or severe chest pain. Some individuals in the study received only the platelet blockers, while others were treated with the drug as well as angioplasty, a procedure that uses a balloon-tipped catheter to restore blood flow in the arteries.

The researchers investigated how well the drugs prevented heart attacks, deaths from any cause, or the need for either angioplasty or bypass surgery, which re-routes blood flow around a blocked blood vessel. The researchers examined the drugs' effectiveness at three intervals: 48-96 hours; 30 days; and six months.

"Using the drugs saves lives, reduces the number of heart attacks, and cuts down on the number of individuals who need repeat angioplasty or by-pass procedures," says Kong. Those who received the platelet blockers had a 30 per cent reduced risk of death than those who did not receive the drugs.

This meant that a person's life was saved for every 1,000 treated, says Kong. There were almost 30 fewer deaths, heart attacks, or need for repeat angioplasty or by-pass for every 1,000 patients treated, and the benefits were significant through six months. The individuals who particularly benefited from the drugs were those who had undergone angioplasty.

In these individuals, the drug was administered just as the coronary arteries were being opened by the balloon-tipped catheters used for the procedure. An estimated five million people in the us would benefit from these new drugs, claim the authors of the study.

Now, studies are underway to test the combination of platelet blockers and clot-dissolving medicines in heart attack patients. Although use of the drugs is increasing for selected patients in hospitals -- and individual studies have indicated benefits for the drugs -- this new study quantifies the overall advantage and shows that the benefits last for as long as six months, notes Kong.

The other 'mainstay' treatment for heart attack is clot-dissolving medicine, but Kong says these drugs are suitable for only 30-50 per cent of heart attack patients in hospitals. Some individuals who cannot be given clot-busters -- those with unstable angina (indicating an impending heart attack), or those who have had mild heart attacks, or those undergoing balloon angioplasty -- may instead benefit from these platelet blockers.

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