Not enough heart attack patients are being treated with thrombolyticdrugs, a government panel concluded in a report published in theFebruary issue of the Annals of Emergency Medicine. The report wasprepared by a working group of the National Heart Attack AlertProgram (NHAAP), a coalition of 39 national scientific, professional,governmental and voluntary organizations administered by theNational Heart, Lung, and Blood Institute (NHLBI) of the NationalInstitutes of Health.
Thrombolytic, or "clot-busting," agents include Genentech Inc.'sActivase (alteplase tissue plasminogen activator, or t-PA), SmithKlineBeecham Corp.'s Eminase (APSAC), and streptokinase, marketed byAstra Pharmaceutical Products Inc.
In a statement released by NHLBI on Tuesday, the NHAAP panelconcluded that "despite the evidence that thrombolytic therapy foracute heart attacks is generally safe and effective, many eligiblepatients do not actually receive this therapy." The panel also statedthat many heart attack patients who are treated with thrombolyticsdo not receive them quickly enough to achieve the greatest benefit.NHAAP suggested that under an "ideal strategy," eligible patientswould receive thrombolytics within an hour of the onset of theirsymptoms.
In the Late Assessment of Thrombolytic Efficacy (LATE) studypublished last October in The Lancet, researchers concluded thatpatients who received intravenous Activase had a 25.6 percentreduction in mortality compared with those receiving placebo iftreated within six to 12 hours of their first symptoms. AfterJ12hours, no significant reduction in mortality was observed. The study,which looked at 5,711 patients in 230 different medical centers, alsoconcluded that patients who received t-PA within three hoursexperienced a 29.6 percent reduction in mortality over placebo. Thestudy did not examine a subgroup of patients who received the drugwithin an hour of the onset of symptoms.
The NHAAP panel suggested changes in the practice of emergencycare medical services to speed the treatment of acute heart attacks.One of their recommendations is that thrombolytic drugs be kept inthe emergency rooms of hospitals rather than hospital pharmacies toavoid delays.
-- Karl A. Thiel Associate Editor
(c) 1997 American Health Consultants. All rights reserved.