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    Blood Test With Super Aspirin Benefits Heart Patients

    People that suffer acute coronary syndromes, the most common form of heart attacks, usually receive blood thinners along with an antiplatelet drug that prevents blood clots from forming. The antiplatelet may be one of a class of new drugs called glycoprotein IIb/IIIa receptor inhibitors, or "super aspirins".

    But until now, doctors believed that platelet inhibitors were not that effective in preventing complications in patients who suffered from acute coronary syndromes.

    However, after examining the data of a study on the glycoprotein IIb/IIIa platelet inhibitor lamifiban, researchers discovered that a blood test can help identify those patients who will really benefit from super-aspirin therapy.

    Researchers from Duke University Medical Center presented the results of the PARAGON B trial on March 13 at the 49th annual meeting of the American College of Cardiology in Anaheim, Calif.

    Super aspirins help to prevent life-threatening blood clots from forming, but unfortunately, said lead investigator Robert Harrington, M.D., their use is minimal. Only about 15 percent of those patients who should receive them actually do. "This shows that we can direct the use of the IIb/IIIa inhibitors (super aspirins) to those patients who can really benefit from them," said Harrington.

    The study showed that patients with troponin T-positive levels in their blood benefited much more from super-aspirin therapy than other patients. Troponin T is a protein that helps heart muscle contract. Once the heart muscle starts dying, troponin T protein is released from the muscle cells and enters the bloodstream. A positive troponin T level is the sign of dying muscle tissue and an ensuing heart attack.

    Patients with positive troponin-T levels have a much higher risk of having complications after suffering a heart attack than those without a positive level. But when troponin-T positive patients are treated with a super aspirin, the rate of complications is reduced by 49 percent.

    "This study shows us that troponin T-positive patients are at a much higher risk of adverse events," Harrington said, "but that they are also the ones who benefit most from what lamifiban and other super aspirins can do."

    The PARAGON B trial involved 5,225 patients in 29 countries. In addition to lamifiban or placebo, the patients also received heparin, an intravenous blood thinner used for decades, and aspirin.


    Editorial Comment: Blood clots in our coronary arteries cause heart attacks. A variety of drugs block their formation and promote their dissolution. The oldest and most proven is aspirin. Clot busters like rt-PA are effective in a subset of patients. For the many heart attack patients with positive troponin T levels, we search for adjunctive therapy, because clot busters are not indicated in the majority of these patients. New drugs such as those described here prevent heart attacks from enlarging. This area is rapidly evolving and can only be studied with large controlled trials, to determine the safest and most effective therapy. We await more controlled studies to validate data.



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