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Faculty and research fellows from the Thrombolysis In Myocardial Infarction (TIMI) Study Group, chaired by Marc Sabatine, MD, MPH, took Chicago by storm when they presented at this year’s American College of Cardiology’s (ACC’s) 61st Annual Scientific Session last month, which attracted more than 19,000 attendees.
Since its founding in 1984 by Eugene Braunwald, MD, the TIMI group has conducted numerous clinical trials in patients with, or at risk for, cardiovascular disease.
“Over the years, many of the findings from our TIMI trials have improved understanding of cardiovascular disease and transformed the care of cardiovascular patients,” said Sabatine. “I am very proud that we are off to a tremendous start this year with the presentation of ground-breaking new trials, as well as intriguing findings from analyses of several previous TIMI trials.”
Studies presented by the TIMI group include the following:
New Anti-Blood Clotting Medicine Cuts Chance of Another Heart Attack
In an international mega-trial of more than 26,000 patients, researchers showed for the first time that adding vorapaxar, an experimental anti-blood clotting medicine, on top of standard therapy, including aspirin, is effective at preventing another cardiac event in stable patients with a prior heart attack.
When used with aspirin and other standard anti-blood clotting therapy in patients with previous heart attack, stroke or peripheral arterial disease, vorapaxar reduced the risk of cardiovascular death, heart attack or stroke by an additional 13 percent. This reduction in new cardiovascular events appeared greatest in patients with prior heart attack.
“It’s exciting to find that we can reduce the risk of a recurrent thrombotic event by adding another platelet inhibitor to aspirin over the long-term,” said David Morrow, MD, MPH, lead study investigator for the TRA2P-TIMI 50 study.
Aspirin Trends Following Heart Attack
Each year, more than one million Americans suffer a heart attack. Nearly all high-risk patients are prescribed a daily aspirin and an anti-blood clotting medicine during recovery. However, the optimal aspirin dose has been unclear. Payal Kohli, MD, and Stephen Wiviott, MD, conducted a study to shed some light on this clinical dilemma.
They reported that there was no significant difference observed in the prevention of heart attack, stroke and cardiovascular death or in the prevention of stent thrombosis (a blood clot in a stent) between patients receiving high-dose aspirin and those receiving a low dose following a heart attack in patients in the TRITON-TIMI 38 study.
“Interestingly, we also found a dramatic difference in practice patterns of physicians in North America compared to those in the rest of the world,” said Kohli. “North American physicians prescribed a high dose of aspirin for two-thirds of all their patients, while the exact reverse was true of the rest of the world. International physicians prescribed a low dose of aspirin to more than two-thirds of their patients.”
The researchers caution that more studies are needed and that all medication changes should be made only after talking to a doctor.
Understanding Complications in PCI Patients
Percutaneous coronary intervention (PCI) is a procedure used to treat acute coronary syndromes (ACS). It involves opening a blocked blood vessel by threading and inflating a balloon-tipped tube into the vessel. Sometimes a stent is also inserted to keep the blood vessel open. While undergoing PCI treatment, doctors usually give patients medicine to prevent complications that may occur from the procedure.
Researchers, led by Benjamin Scirica, MD, MPH, investigated the types and timing of these complications. They also studied the effectiveness of two medicines, prasugrel (Effient) and clopidogrel (Plavix), in preventing these complications.
They found that most complications occur as a side effect of PCI treatment, and within the first 30 days after treatment. When comparing the two preventive drugs, the researchers found that prasugrel was better at preventing complications compared to clopidogrel.
Ticagrelor Effective at Reducing First, Recurrent and Overall Cardiovascular Events
Ticagrelor (Brilinta), a potent anti-blood clotting medication, is known to significantly reduce the risk of stroke, heart attack and death in patients with acute coronary syndromes (ACS). After studying patients taking aspirin plus ticagrelor or clopidogrel (Plavix) following ACS, researchers reported that ticagrelor not only increased the time to first cardiovascular death, stroke or heart attack, but it also significantly increased the time to a second cardiac event or death.
“Interestingly, we also found that those patients who had more cardiac events tended to be older and have a lower body weight and a higher number of cardiovascular risk factors. There were also a higher proportion of females in this group,” said Payal Kohli, MD.