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Clot Dissolver Doesn't Boost Survival in Cardiac Arrest Patients
Date:12/17/2008

e hearts to stop, but it proved to be ineffective in the vast majority of patients -- those whose cardiac arrest was due to blockage of a major heart artery.

Failure to improve the overall survival rate was "a result that was not expected," Böttiger said. Although 17 percent of the people given standard emergency treatment in the trial survived, he attributed that the higher-than-average rate to the quality of care at the centers that participated in the study, describing it as "something that you can reach in such excellent emergency case systems, but only there."

Now the researchers are devising possible new trials with variations on the theme. "We haven't used thrombolysis [clot-busting] in combination with an anticoagulant," a drug that prevents formation of clots, Böttiger mused. "We could try heparin or other anticoagulants," he said. "We have several ideas and are working out different plans. I am absolutely convinced that it will result in a successful method. This is supported by a huge amount of animal studies, but the next step has not been decided."

Meanwhile, Böttiger said, administration of tenecteplase for someone who has sudden cardiac arrest "should be considered where pulmonary embolism is the suspected cause of the arrest."

Dr. Richard Pomerantz, clinical chief of cardiology at the University of Rochester in New York, said that giving a clot-busting drug such as tenecteplase when cardiac arrest is caused by a lung clot seems reasonable "because the heart itself is not in bad shape." But he said he is skeptical about its value when a heart artery blockage is the cause.

"First, there is small likelihood of being able to get the clot-dissolving medication to the area where it is needed because there is relatively low blood pressure," Pomerantz said. "Then, it takes awhile for it to work. It isn't a magic thing that opens the clot at once. It can take an hour or more for it to work."'/>"/>

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