These findings, coupled with an assessment of ease of administration and cost compared to other drugs, leads researchers from Duke University Medical Center to recommend the drug enoxaparin, which is a low-molecular weight heparin, for acute heart attack patients with diabetes.
The Duke team reported the results of its analysis today (Nov. 20, 2002) at the 75th annual scientific session of the American Heart Association.
When heart attack patients are rushed to the emergency room, physicians immediately try to restore blood flow to the heart, usually by giving medications that dissolve clots in the coronary arteries. Since no one drug has been totally effective on its own in opening clogged arteries and keeping them open, researchers have tried different combinations of agents.
Thus was born the ASSENT-3 trial, the results of which were published in August 2001 in the journal Lancet. The trial enrolled 6,116 patients and documented the combined rates of death, recurrent heart attack or refractory chest pain. They then used this composite endpoint to measure the effectiveness of three different combinations of drugs.
All patients entered the hospital within six hours of a heart attack and were given varying doses of tenecteplase, a genetically altered version of the well-known clot-buster t-PA, which quickly dissolves the blood clot. Patients were then randomized to receive additional agents intended to keep the vessels clear: the blood-thinner enoxaparin; the blood-thinner unfractionated heparin plus abciximab (an agent that keeps platelets in the blood from clumping); or unfractionated heparin alone.