DURHAM, N.C. The deaths or clinical complications in heart attack patients given potent drugs to re-open clogged arteries is more likely to be due to individual patient characteristics than to modest misdosing of the drugs, researchers from the Duke Clinical Research Institute (DCRI) have determined. Thus, they said, physicians should not be overly worried about the possibility of minor errors in dosing -- a concern that the Duke physicians said likely contributes to insufficient prescribing of the drugs to treat heart attacks.
These findings are important, the researchers said, because approximately one in three patients rushed to emergency rooms with heart attack symptoms do not receive these potentially life-saving drugs. One reason cited for this under-usage is that many physicians may be overly albeit sometimes justifiably -- concerned about potential adverse events due to incorrect dosing, the researchers said.
The drugs, known as fibrinolytic agents, have been proven effective in clinical trials in breaking apart blood clots in coronary arteries, restoring blood flow to heart and saving heart muscle. The doses of some of the drugs in this class are determined by a calculation that includes body weight, which must often be estimated in emergency situations. The amount of drug administered is crucial, the researchers said, since too much can cause unwanted bleeding events, while too little will not dissolve the blood clot.
"Many physicians have assumed that modest errors in dosing errors of these fibrinolytic drugs can cause harm, which made them afraid to give the drugs altogether," said Duke University Medical Center cardiologist Christopher Granger, M.D., senior member of the research team that published the results of their analysis in the April 13, 2005 issue of the Journal of the American Medical Association. The DCRI's Rajendra Mehta, M.D. was the first author of the paper.
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Contact: Richard Merritt
Duke University Medical Center
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