quarta-feira, 5 de setembro de 2007

Os stents farmacológicos, mais uma vez evidência de risco.

Novamente os stents farmacológicos para o tratamento da doença coronariana. Sempre no mesmo palco, o Congresso Europeu de Cardiologia. Nas próximas semanas choverão desmentidos dos estudos abaixos. Vamos ver como se comportarão as ações da Boston Scientific e da Johnson & Johnson. Aqui no Brasil, a "solução" foi e continuará simples: stents farmacológico para todos e clopidogrel (Plavix) para todos para evitar estenose tardia. Afinal, dinheiro aqui não é problema, é solução. Depende para quem.....
Drug-Coated Stents Are Questioned A WSJ NEWS ROUNDUPSeptember 5, 2007; Page D7 VIENNA -- Patients given drug-coated stents after an acute heart attack are nearly five times as likely to die six months to two years later as those with bare metal forms of the arterial scaffolding, new research showed. The finding, from a two-year analysis of 2,300 patients in 14 countries, fuels the debate over the safety of so-called drug-eluting stents, made by companies such as Boston Scientific and Johnson & Johnson. Doctors at the European Society of Cardiology meeting said the finding showed the need to be very selective about giving drug stents to the right patients. At the same time, experts emphasized that there were differences among the patients in the study that could have affected the outcome, and that these findings aren't the final word on the safety of drug-coated stents for heart-attack patients. Gabriel Steg of the Hospital Bichat-Claude Bernard in Paris followed the fate of patients who were given stents -- tiny wire-mesh tubes used to prop open clogged heart arteries -- following the most deadly kind of heart attack. For the first six months, those on drug stents did as well as those on bare ones. But after 180 days, the drug-stent patients were 4.7 times as likely to die, with a mortality rate of 8.6%. Dr. Steg said the trend probably reflected the high thrombosis risk in this group of patients. Drug stents are known to carry a small risk of blood clots after the first year, known as "late stent thrombosis." This occurs in less than 1% of patients but kills nearly half of those affected. Dr. Steg said many heart patients with less acute conditions could still benefit from drug stents, which help prevent arteries narrowing again. "I still believe there is room" for drug-eluting stents "in many patients and I disagree with the concept of banning" drug-eluting stents altogether, Dr. Steg said. Drug stents remain controversial in the cardiology community and fears about late stent thrombosis have led to a slump in sales in the past year. Eckhart Fleck, director of cardiology at the German Heart Institute in Berlin and a spokesman for the European Society of Cardiology, said the findings were serious and showed that doctors shouldn't be indiscriminate in use of drug stents. "This study will make doctors less enthusiastic about using drug-eluting stents," said Spencer King, a cardiologist at Fuqua Heart Center in Atlanta and spokesman for the American College of Cardiology. "The concerns about safety may make doctors shy away." Johnson & Johnson said in a statement the results were inconsistent with the findings of other analyses of patient records and with all currently available randomized controlled trials. Boston Scientific, separately, said the lower mortality seen in patients one year after receiving bare-metal stents was atypical when compared with earlier data on the company's Taxus stent. It said a study, which has just completed enrolling 3,000 heart attack patients, is now under way comparing Taxus with bare-metal stents. A Swedish study presented Sunday, involving 35,000 patients, found no overall increased risk for heart patients between drug and bare stents after four years of follow-up -- a reversal of the same researchers' earlier three-year findings that patients with coated stents were more at risk

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