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

DATE: SATURDAY, May 1, 1993                   TAG: 9305010166
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A5   EDITION: METRO 
SOURCE: Associated Press and The New York Times
DATELINE:                                 LENGTH: Medium

U.S. 'CLOT BUSTER' TOP LIFESAVER

A last-stand shootout between two rival drugs for treating heart attacks has led to a surprising win for the less-favored, according to a large international study reported in Washington on Friday.

The result is important both for treatment of heart attacks, the most common cause of death in the United States, and for heavy extra costs for the health care system.

Researchers said that the American drug called tissue plasminogen activator, or t-PA, was more effective than an older drug from Europe, streptokinase.

The result will pose an agonizing dilemma for doctors, patients and the health care system because the benefit of TPA comes at a high cost to society for the few whose lives are prolonged. The researchers say they calculated that the total cost of TPA treatment, measured against the life extension of patients who benefitted, worked out to a net cost of $22,000 for each year of life saved.

Both drugs are called "clot busters," or thrombolytic compounds, that dissolve blood clots that can cause heart attack by clogging coronary arteries. The drugs generally are administered in hospital emergency rooms after tests show that a patient has experienced a heart attack.

First issued in the mid-1980s, t-PA failed to live up to forecasts of wide acceptance. T-PA costs about $2,200 a dose, while streptokinase costs about $200. Earlier studies did not show a significant medical difference between the two drugs.

T-PA is manufactured and marketed under the name Activase by Genentech Inc. of South San Francisco. Trading of the company's stock on the New York Stock Exchange was halted at noon at the firm's request. When trading resumed after results of the heart attack study were announced, the Genentech stock shot up.

The study involved more than 41,000 patients at 1,100 hospitals. A unique element of the study called for 25 percent of the patients to receive the standard t-PA dose in just 90 minutes instead of over three hours. This rapid injection appeared to increase patient survival, said Dr. Eric J. Topol, chairman of the study and a professor of medicine at the Cleveland Clinic.

Genentech reportedly invested about $55 million in the new study to produce the largest heart attack trial ever.

Dr. Robert M. Califf of Duke University, a leader in the study, said that the work proved conclusively that the speed with which clogged arteries are opened by drugs does affect survival of heart attack patients. This point had been controversial among heart experts.

by CNB