BFP Magazine

Cardio-vascular Health

Coronary Arteries, rTPA

Have Doctors finally discovered a "Drano" for Humans?

By Dr. W. Gifford Jones

Have we finally discovered the "Drano" that is desperately needed by millions of North Americans' coronary arteries? Year after year an estimated 1.5 million people in Canada and the US. suffer a heart attack. The result is 600,000 deaths of which 300,000 die before they reach a hospital. Now researchers have discovered a new drug, rTPA, which acts like Drano to unplug coronary vessels. Who should and who shouldn't be given this drug? How effective is this human Drano? And should an ampoule of rTPA be kept at the summer cottage?

Heart attack occurs when a fatty atherosclerotic plaque ruptures and a clot forms on the plaque blocking the flow of blood in coronary arteries. This obstruction deprives the heart muscle of oxygen and food needed for survival.

But suppose the patient survives the acute myocardial infarction . He or she may still be left a cardiac cripple due to the prolonged deprivation of oxygen which causes extensive damage to the heart's muscle. Plugged coronary vessels, like clogged toilets, cause more trouble the longer they're plugged.

Dr. Philip A Ludbrook , a cardiologist , helped to direct clinical studies on rTPA at the University of Washington School of Medicine in St. Louis. He reports, "It's the best treatment available,and can be given anywhere, from a small community or rural hospital to a big city emergency centre. That's the beauty of rTPA."

Dr. Susan Lenkei, a prominent Toronto cardiologist,says the prompt use of rTPA will remove the clot from 70 per cent of the coronary arteries. This quick dissolution of the clot will save about half of the patients from suffering damage to the heart's muscle. It will also result in a 50 per cent reduction in mortality. But she stresses that time is an enormous factor in the effectiveness of rTPA. The drug must be given within the first two to three hours. If it's administered five to six hours after the clot has formed it's like closing the barn door after the horse has escaped.

Human frailty will undoubtedly prevent the drug from living up to expectations. Some patients with chest pain will stubbornly decide to stay in bed at 1 a.m. rather than go to hospital. Others will convince themselves that the sudden discomfort is due to indigestion. And valuable time will be lost.

rTPA is not a new concept. Rather , it's the latest attempt by doctors to either stop a blood clot from forming or to dissolve one that's present. Blood clotting is a very complicated process. Platelets, small fragments manufactured by bone marrow,initiate a clot by adhering to the damaged inner lining of a blood vessel. Continued clumping of the platelets eventually causes the formation of a clot.

In the past doctors tried various drugs in an effort to impede the formation of blood clots. It's been known for some time that an Aspirin every day decreases the stickiness of platelets and hinders clot formation. Patients who suffer increased risk of heart attack and stroke, and those who've had coronary by-pass surgery are advised to take daily Aspirins. Other medications

such as Heparin and Coumadin thin the blood and interfere with the blood clotting mechanism. And prior to rTPA, Streptokinase was the first human Drano doctors used to dissolve coronary clots. It's still a good drug for this purpose but must be given within the first hour of a heart attack. And it costs a few hundred dollars compared to several thousand for rTPA.

rTPA isn't the be- all and end- all to prevent coronary deaths. Some patients will still die before they reach a hospital or receive an injection of rTPA. It can also cause hemorrhage and death if given to patients with peptic ulcer, hypertension and those on anticoagulants. And although it can remove blood clots it cannot dislodge the underlying biological rust of atherosclerosis which set the stage for the blood clot.

rTPA could prove to be the major cardiovascular breakthrough of this decade. Some interesting possibilities are suggested. For instance, we advise people who are allergic to insect stings to keep an injection of adrenaline at the summer cottage. Yet every summer people die because this inexpensive kit is not available.

But suppose you're suffering from angina and have a heart attack at the cottage miles from the nearest hospital? Having an ampoule of rTPA on hand could save your life. But it could also end your days if the pain is due to a bleeding stomach ulcer. Or you've wasted several thousand dollars if the chest pain is just indigestion. Self medication is always a risky affair and it's recommended only for emergency situations. The possibilities of rTPA are very exciting and we'll hear much more about this drug in the years ahead.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: www.mydoctor.ca/gifford-jones. He can be reached at bfp@bogotafreeplanet.com

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