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Clot Busters Fail to Improve Outcomes in Out-of-Hospital Cardiac Arrest Patients: Presented at WCC

By Ed Susman

BARCELONA, SPAIN -- September 6, 2006 -- Attempts to improve outcomes among people who suffer out-of-hospital cardiac arrest by administering the clot-busting drug tenecteplase failed to differentiate from placebo.

"We were surprised to find that the addition of tenecteplase to standard cardiopulmonary resuscitation did not increase the survival rate," said Bernd Bottiger, MD, associate professor of anesthesiology, University of Heidelberg, Heidelberg, Germany.

Researchers attempted the large study based on findings from small-scale studies, which hinted of a benefit of thrombolysis during resuscitation, Dr. Bottiger said in a presentation here on September 5^th at the European Society of Cardiology World Congress of Cardiology (WCC).

Despite the finding that tenecteplase did not improve 30-day survival, "we still think that the use of thrombolysis in cardiac arrest witnessed outside the hospital may still be considered on a case-by-case basis," Dr. Bottiger said.

The study, conducted at 10 German hospitals, had been designed to enroll 1,300 patients, to be randomly assigned to receive either tenecteplase in addition to emergency resuscitation or usual treatment without receiving the clot-busting drug. However, the trial was halted after 1050 patients were enrolled because the study's Data Safety and Monitoring Board determined there was little chance that the treatment would show a benefit.

Dr. Bottiger said that there was no statistically significant difference between the 2 groups in rates of hospital admission, ability to restore circulation, 24-hour survival, or survival for 30 days, or until hospital discharge.

The failure to differ from placebo -- 18.2% for patients who received tenecteplase and 20.2% for placebo patients (P = .512) -- might have been caused by several factors, he said. Those factors include:

- Thrombolysis is not generally effective in cardiac arrest.
- Timing of tenecteplase administration might have been too early or maybe too late after resuscitation.
- Negative interactions occurred between patients and drugs such as vasopressors.
- Need for adjunctive antithrombolytic therapy.

"Cardiac arrest remains a high-mortality syndrome with no specific treatment even when the arrest is witnessed." Dr. Bottiger said.

The study was supported by a grant from Boehringer Ingelheim, Germany.


[Presentation title: Thrombolysis in Cardiac Arrest Trial. Hot Line Report]

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