November 13, 2005
Stent patients go home sooner if wrist artery used
By Ransdell Pierson and Bill Berkrot
DALLAS (Reuters) - Many patients whose coronary stents are
delivered through an artery in the wrist instead of through a
groin artery do not require overnight hospitalizations that are
now standard for 1 million Americans each year, researchers
said on Sunday.
Patients in a new trial were able to go home within hours
because use of the wrist's radial artery -- a far smaller blood
vessel than the groin artery -- reduced the amount of Johnson
and Johnson's ReoPro blood thinner needed to control bleeding.
"Zero percent of patients getting stents now go home the
same day for fear of bleeding complications, but this trial
suggests possibly half of them should be able to do so," said
Dr. Olivier Bertrand, an assistant professor of medicine at
Laval University in Quebec City, Canada.
Bertrand, who described his study at the annual scientific
meeting of the American Heart Association, said about 1 million
stent procedures are performed every year in the United States.
Doctors use the tiny mesh tubes to prop open coronary arteries
that have been cleared of plaque.
"If you can discharge patients safely and early, you can
free up a lot of hospital beds and save the health-care system
a lot of money," Bertrand said.
The trial was sponsored by Johnson & Johnson and its
partners Eli Lilly and Co. and Sanofi-Aventis. Their drug
ReoPro competes with Merck & Co.'s similar anti-clot medicine
Aggrastat and Schering-Plough Corp.'s Integrilin.
Patients receiving stents are given one of the drugs during
the procedures to reduce complications, especially heart
attacks. But they currently must be kept in the hospital one or
more additional days to monitor internal and external bleeding
linked to the blood thinners.
But in the trial, patients given a single injection of
ReoPro before the stent was delivered were safely discharged 4
to 6 hours later. About 13.5 percent of them died, had heart
attacks or other serious complications within 30 days.
That compared with 10.2 percent of patients who died or had
such complications after the usual treatment with an initial
dose of ReoPro and later 12-hour infusion of the drug that
required hospitalization. The difference in complications
between the groups was not considered statistically
"This study shows that the combination of delivering of
stents through the wrist artery, while using a single dose of
ReoPro, is extremely safe and allows even high-risk heart
patients to go home the same day," Bertrand said.
Bertrand, whose hospital has been a pioneer in using the
wrist-artery method of delivering stents, said the new study
validates the method.
He said it also could give ReoPro an advantage over
Aggrastat and Integrilin, which require long intravenous
infusions and overnight hospitalizations after stenting