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    Prediction: New "Super Aspirin" Will Change How Doctors Treat Angioplasty Patients

    One of the new so-called "super aspirin" drugs appears to reduce death and heart attacks in patients who undergo balloon angioplasty, according to
    medical researchers at Duke University. And as a bonus, the new drug costs only a third as much as an earlier drug in the same class.

    "We think this study will change the way doctors practice medicine," said lead investigator, James Tcheng, M.D., of Duke University Medical Center.
    He presented the results of the ESPRIT trial (Enhanced Suppression of the Platelet Receptor glycoprotein IIb/IIIa using Integrilin Therapy) at the
    49th annual meeting of the American College of Cardiology in Anaheim, Calif.

    The researchers looked at whether eptifibatide (trade name Integrilin) prevented complications 48 hours after patients underwent angioplasties.
    The double-blind, randomized, placebo-controlled study involved 2,064 patients in 92 hospitals in the United States and Canada. All underwent
    balloon angioplasty. The procedure involves placing a catheter in an obstructed artery, then inflating a small balloon that presses against the
    walls of the artery to open it. Balloon angioplasty can cause trauma to the wall of the artery, sometimes causing platelets to clump together and form
    a blood clot.

    Researchers found that if they gave patients eptifibatide intravenously just before, during and after balloon angioplasty, the complications were
    greatly reduced in the 48 hours following the procedure.

    More specifically, they found that:

    ∑ Overall complications were reduced by 37 percent.
    ∑ The number of deaths and heart attacks were reduced by 40 percent.
    ∑ The need to perform a second emergency angioplasty or bypass surgery was reduced by 40 percent.

    The study was discontinued early, Tcheng said, because there was such a significant difference in outcomes between those who received eptifibatide
    and those who received the placebo. Researchers are excited for another reason. Eptifibatide costs about $400 to administer, while abciximab (trade name Reopro), a drug in the same class, costs $1200. Both are glycoprotein IIb/IIIa inhibitors, which work by blocking a receptor on platelets that are responsible for the formation
    of blood clots.

    "Only about 20 percent of the patients who currently undergo a coronary angioplasty with stent receive platelet inhibitor therapy," Tcheng said.
    "One of the main reasons is because of cost. We think we've finally eliminated the financial barrier to using this."

    To put the study in perspective, there are more than 600,000 people in the United States who undergo balloon angioplasty each year. More than 80
    percent of these procedures place a stent, a mesh-like device that helps hold the artery open.


    Editorial Comment: About five percent of angioplasties result in complications. For example, a blood clot may form at the site of the angioplasty and cause a heart attack more severe than if the patient did not have an angioplasty. In many cases, the patient is urgently admitted for a bypass surgery.

    In an attempt to prevent such complications, researchers focus on preventing blood clots from forming in the stent or angioplasty site at the time of the
    procedure. Abciximab was shown to be the first effective drug in preventing clots after angioplasty. Newer drugs using the mechanism described here are likely to be as effective and less expensive. This area is rapidly evolving and we will likely see angioplasty patients receiving such agents. However, the drugs increase the risk of bleeding. As always, physicians must weigh the risks against the benefits.



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