An international study to resolve a decade of debate over the best timing for administering an anti-clotting drug for certain heart patients has come up with an answer: It doesn't matter.
Patients with coronary artery disease who are at high risk for complications after a heart attack often need procedures to check their arteries for blockages. During those procedures, physicians use an anti-clotting agent called eptifibatide (marketed as Integrilin) to prevent potentially life-threatening complications. But practice guidelines are not clear on when the drug should be used. Is it better to administer eptifibatide in the emergency room, when patients come in with chest pain and are first diagnosed with acute coronary disease? Or is it better to give it later, if needed, during procedures to open blocked arteries?
According to findings from The Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome (EARLY-ACS) trial, the answer is - it's a draw. The timing of the drug doesn't appear to make much difference at all.
The findings were released today at the American College of Cardiology's 58th Annual Scientific Session and simultaneously published online in the New England Journal of Medicine .
"This study answers a question we have debated for nearly ten years," says L. Kristin Newby, M.D., a member of the Duke Heart Center and senior author of the study. "World-wide, there is quite a bit of variability in how eptifibatide is used. Interpretation of current guidelines differs by region, and one could successfully argue that the guidelines support both approaches. We thought it was important to clarify if one strategy were better than the other."
Eptifibatide blocks a key platelet receptor that triggers a clotting reaction whenever there is injury to the body. Patients with non-ST-segment elevation acute coronary syndromes often have problematic plaque build-up that results in chest pain and increased susceptibility to platelet-driven events that could block blood flow to the heart.
Newby and colleague Robert Giugliano, M.D., Senior Investigator, TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School and lead author on the paper, led a team of investigators to determine if early use of eptifibatide among high-risk patients with coronary artery disease was superior to later use of the drug. Enrollment in the double-blinded, placebo-controlled trial began in 2004. By 2008, the study had enlisted 9,492 patients at 440 sites in 29 countries.