Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: THURSDAY, July 19, 1990                   TAG: 9007190309
SECTION: NATIONAL/INTERNATIONAL                    PAGE: C-5   EDITION: METRO 
SOURCE: The New York Times
DATELINE:                                 LENGTH: Medium

DRUG FOUND TO CUT HEART ATTACK RISK

The drug, warfarin, limits the ability of the blood to clot.

It came into use in the early 1950s, but most doctors later rejected it for routine use, in large part because of conflicting results from subsequent studies.

The new research, the largest controlled study ever done on the drug, found that warfarin cut the risks of a new heart attack by a third, death by a fourth and strokes by a half.

The risk of bleeding and other complications from the drug was also much lower than expected.

Dr. Pal J. Smith's team of Norwegian researchers is reporting in today's edition of The New England Journal of Medicine.

The findings have come as a surprise to cardiologists, and some said treatment of heart attacks would need to be re-evaluated.

Smith said he believed that warfarin was probably twice as effective as aspirin, the most common current therapy, in preventing new heart attacks in people who have already had one.

But other researchers said the two drugs appeared roughly comparable. Whatever the case, the success of warfarin will now give an alternative to patients who are sensitive to aspirin and may eventually allow doctors to prescribe combinations of the two drugs to increase effectiveness or reduce side effects.

This year as many as 1.5 million Americans will have a heart attack and more than 500,000 of them will die, the American Heart Association says.

At least 3 million Americans are still alive after suffering a heart attack, and each year more than 500,000 Americans survive an initial heart attack, according to the National Heart, Lung and Blood Institute in Bethesda, Md.

Warfarin is an anti-coagulant pill that has been sold for 36 years under the name Coumadin.

It is used extensively among people at high risk of death and strokes from certain complications of heart attacks, like an abnormal heart rhythm called atrial fibrillation.

But as recently as 1988, for example, an editorial in The American Heart Journal recommended against routine long-term anti-coagulation therapy for heart attacks because of a lack of evidence of its beneficial effects.

Now the Norwegian study and other studies show that anti-coagulant drugs are far more effective in treating heart attacks than most doctors believed.

The new findings may bring the warfarin story almost full circle from the 1940s, when the drug was first synthesized.

It was not used in people; doctors believed it was too toxic for human use until someone survived a suicide attempt from an overdose in 1951.

Smith and other experts said researchers should conduct large studies for directly comparing warfarin with aspirin, which has been shown to reduce heart attack risk.

While Smith said warfarin appeared to be about twice as effective as aspirin in preventing second heart attacks, Dr. Richard Peto of Oxford University in England and Dr. James H. Chesebro of the Mayo Clinic in Rochester, Minn., said the benefits of the two drugs appeared to be similar.