- THURSDAY, Aug. 14 (HealthDay News) — Giving a high dose of the
anti-clotting drug tirofiban to heart attack victims while on route to the
hospital could improve their chances of survival, a new report says.

The study, published in a special cardiology issue of The Lancet
this week, showed that patients given tirofiban in addition to the
standard triple treatment of the anti-clotting agents aspirin, heparin and
clopidogrel had significant less blockage affecting their heart than those
given only the three standard medicines and a placebo.

The researchers — lead by Arnoud van't Hof, Isala Klinieken of the
department of cardiology, Zwolle, Netherlands — found that major bleeding
did not differ significantly between the two groups (4 percent of patients
in the tirofiban group and 3 percent in standard group).

“Our trial was not powered on a difference in clinical outcome between
the two groups. However, we noted a better clinical outcome in the
tirofiban group than in the placebo group, with lower overall mortality
and less urgent repeat [primary coronary angioplasty],” the authors
wrote.

In an accompanying comment, Gilles Montalescot of the Institute of
Cardiology Piti-Salptrire Hospital, INSERM 856 and University of Paris 6,
Paris, wrote that the study “reveals that high-dose clopidogrel is not
effective enough and confirms the need for fast and strong platelet
inhibition. It reminds us also that the first contact with the patient
must be rapid and medical. Until now, only well-organized hospital systems
have been able to provide such a service.”

The special issue of The Lancet also features an article about a
study that says while a combination therapy of angiotensin-converting
enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) reduces
more excess protein in the urine (proteinuria) than either therapy alone
in patients at high vascular risk, it could also result in greater kidney
damage.

Proteinuria can be a sign of kidney damage, as malfunctioning kidneys
allow proteins into the urine. Diabetes is the most common cause of
proteinuria, although a range of other conditions can cause it.

An accompanying comment by doctors from University of Thessaloniki in
Greece and the University of Chicago concluded “these data should not lead
to guideline modifications … Combined with previous studies, [this
study] supports the notion that use of single agents to block the
renin-angiotensin system is well-tolerated.”

More information

The U.S. Heart, Blood, and Lung Institute has more about current heart attack treatments.