Duke University Clinical Cardiology Study - 1 - DUCCS-1

Description:

Withholding heparin following anistreplase to reduce MI complications.

Hypothesis:

To examine whether withholding heparin following anistreplase thrombolytic therapy reduces complications of myocardial infarction.

Study Design

Study Design:

Patients Screened: Not given
Patients Enrolled: 250
Mean Follow Up: 5 days

Patient Populations:

Acute MI within 6 hours

Primary Endpoints:

Death, reinfarction, recurrent ischemia, occlusion of infarct related artery

Drug/Procedures Used:

Heparin (15 U/kg 4 hours after anistreplase) or no heparin

Concomitant Medications:

Anistreplase (APSAC), aspirin, beta blockers, nitrates

Principal Findings:

Of the 250 patients enrolled, 128 patients were randomized to receive heparin and 122 were randomized to no heparin.

There was no difference detected in the primary endpoint between patients who received heparin and those who did not (42% vs 43%, respectively).

Bleeding complications were more frequent for the heparin group (32% vs 17.2%, p = 0.006), with life-threatening bleeds in 4.7% of heparin-treated patients compared to 0.8% of patients not receiving heparin.

Interpretation:

The DUCCS-1 trial showed that combining heparin with APSAC therapy was associated with a significant increase in hemorrhagic complications, without additional benefit. Although not powered to exclude a benefit in ischemic complications, the benefit of heparin with APSAC was likely to be small compared to the risk of bleeding. Concomitant heparin therapy has been of net benefit in the setting of other thrombolytic agents (ISIS-3, GUSTO-1).

References:

1. J Am Coll Cardiol 1994;23:11-8.

Clinical Topics: Anticoagulation Management, Dyslipidemia, Lipid Metabolism, Novel Agents

Keywords: Thrombolytic Therapy, Myocardial Infarction, Streptokinase, Heparin, Anistreplase, Fibrinolytic Agents


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