Approximately 15.5 million cardiovascular deaths occur every year, according to background information in the article. Of these, about half are likely to be due to acute myocardial infarction (MI, [heart attack]). Although reperfusion therapy (restoration of blood flow), aspirin, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors reduce the risk of death when used early in patients after a heart attack, the rate of death and illness remains high. No antithrombotic or newer antiplatelet drug has been shown to reduce the risk of death after a heart attack.
Salim Yusuf, D.Phil., F.R.C.P.C., of Hamilton General Hospital and McMaster University, Ontario, Hamilton, Canada, and colleagues evaluated the effects of reviparin on the composite outcome of death, heart attack, and stroke at 7 and 30 days. The randomized, double-blind, placebo-controlled trial (Clinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation [CREATE]), included 15,570 patients with ST-segment elevation (a specific finding on the electrocardiogram ) or new left bundle-branch block (a slowing in the flow of electrical pulses that drive the heart beat). The patients presented within 12 hours of symptom onset at 341 hospitals in India and China from July 2001 through July 2004. Patients received reviparin (n = 7,780) or placebo (n = 7,790) subcutaneously twice daily for seven days.
The researchers found that the primary composite outcome was significantly reduced from 11.0 percent of patients in the placebo group to 9.6 percent in the reviparin group, a 13 percent lowered risk. These benefits persisted at 30 days (13.6 percent vs. 11.8 percent) patients, a 13 pe
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