NICE approves new treatment for heart attacks
NICE has today recommended the use of the drug bivalirudin (Angiox) in combination with aspirin and clopidogrel, for the treatment of adults who have had a type of myocardial infarction called a ST-segment-elevation myocardial infarction or 'STEMI' who are undergoing primary percutaneous coronary intervention.
STEMI is caused by narrowing and blockage of the main blood vessel (the coronary artery) that delivers blood to the heart.
Each year around 180,000 people in the UK are admitted to hospital with an MI and nearly 30,000 people in England and Wales die.
The condition occurs most frequently in people aged over 50 years, and becomes more common with increasing age. MI is three times more common in men, and South Asian men are at higher risk.
Current standard treatments for STEMI aim to re-open the blocked artery. They include primary PCI, a surgical procedure where fine wires, balloons or stents are inserted into the arteries to disrupt the blood clot and to open the coronary artery.
Treatments used in conjunction with primary PCI for people with STEMI are anticoagulants (heparin and low-molecular-weight heparin), which prevent the blood from clotting, and anti-platelet drugs (these include a class of anti-platelet drugs called glycoprotein IIb/IIIa inhibitors, as well as aspirin, clopidogrel and prasugrel) to prevent platelet aggregation and blood clot formation.
Bivalirudin is a type of anticoagulant, and is given intravenously at the time of the PCI, together with aspirin and clopidogrel, to prevent blood from clotting during the procedure.
The NICE appraisal compared bivalirudin with the commonly used anticoagulant heparin, used in conjunction with glycoprotein IIb/IIIa inhibitors.
Dr Carole Longson, NICE Health Technology Evaluation Centre Director, said:"With the number of PCIs being carried out increasing each year, this guidance provides the NHS in England and Wales with another important tool to enable it to treat people who have had a heart attack more effectively.
“The independent committee that advises NICE considered that, on the basis of the available evidence, bivalirudin, in combination with clopidogrel and aspirin, is both more effective and less expensive than treatment with a glycoprotein inhibitor plus heparin. It is also associated with a lower incidence of major bleeding events compared with heparin and glycoprotein inhibitors."
27 July 2011