Cheaper drug for heart attack procedure improves outcomes

A drug used to prevent blood clot formation during emergency heart attack treatment could result in improved outcomes compared to another drug which is in widespread use in high-income countries, and is around 400 times more expensive.
The study, published in The Lancet, compared the outcomes for two drugs used to prevent blood clot formation during emergency heart attack treatment.
The study suggests that use of one of the drugs, heparin, could result in improved outcomes (such as a reduced rate of repeat heart attacks), compared to the other more expensive drug, bivalirudin.
The results of the trial suggest that systematic use of heparin rather than bivalirudin after primary percutaneous coronary intervention (PPCI) - the most commonly used treatment for heart attack, which unblocks the arteries carrying blood to the heart - could save health services substantial sums of money, at the same time as potentially improving patient outcomes.

Patients who undergo PPCI usually receive a combination of antithrombotic drugs to prevent any further blood clots forming during the procedure and after it has been completed.
The most commonly used antithrombotic drugs are unfractionated heparin and bivalirudin, and although several previous trials have compared the two drugs, the evidence is unclear as to which drug results in better outcomes.

The trial took place at the Liverpool Heart and Chest Hospital in the UK, where 1,829 patients undergoing emergency angiography (an x-ray examination of the heart's arteries after a suspected heart attack) were recruited to the trial.
More than four fifths of these patients then went on to receive PPCI; approximately half received heparin, and half received bivalirudin.

Researchers then recorded how many patients in both groups experienced a major adverse cardiac event, such as death or another heart attack, within 28 days after surgery.
The results show that overall rates of major adverse cardiac events were significantly lower in the group who received heparin, although the rates of adverse events were low, as expected, in both groups.
Within 28 days after surgery, 46 patients in the bivalirudin group died, compared to 39 of patients in the heparin group; 24 patients in the bivalirudin group had another heart attack in the same period, compared to 7 patients in the heparin group.

"The results suggest that the use of heparin has some advantage over bivalirudin in avoiding major adverse events, mainly in terms of reduced recurrent, additional heart attacks in patients recovering from PPCI," said lead author Dr Rod Stables, of the Liverpool Heart and Chest Hospital NHS Foundation Trust, UK.