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Stent Patients Go Home Sooner If Wrist Artery Used

DALLAS (Reuters) - Many patients whose coronary stents are delivered through an artery in the wrist instead of through a groin artery do not require overnight hospitalizations that are now standard for 1 million Americans each year, researchers said on Sunday.

Patients in a new trial were able to go home within hours because use of the wrist's radial artery -- a far smaller blood vessel than the groin artery -- reduced the amount of Johnson and Johnson's ReoPro blood thinner needed to control bleeding.

"Zero percent of patients getting stents now go home the same day for fear of bleeding complications, but this trial suggests possibly half of them should be able to do so," said Dr. Olivier Bertrand, an assistant professor of medicine at Laval University in Quebec City, Canada.

Bertrand, who described his study at the annual scientific meeting of the American Heart Association, said about 1 million stent procedures are performed every year in the United States. Doctors use the tiny mesh tubes to prop open coronary arteries that have been cleared of plaque.

"If you can discharge patients safely and early, you can free up a lot of hospital beds and save the health care system a lot of money," Bertrand said.

The trial was sponsored by Johnson & Johnson and its partners Eli Lilly and Co. and Sanofi-Aventis. Their drug ReoPro competes with Merck & Co.'s similar anti-clot medicine Aggrastat and Schering-Plough Corp.'s Integrilin.

Patients receiving stents are given one of the drugs during the procedures to reduce complications, especially heart attacks. But they currently must be kept in the hospital one or more additional days to monitor internal and external bleeding linked to the blood thinners.

But in the trial, patients given a single injection of ReoPro before the stent was delivered were safely discharged 4 to 6 hours later. About 13.5 percent of them died, had heart attacks or other serious complications within 30 days.

That compared with 10.2 percent of patients who died or had such complications after the usual treatment with an initial dose of ReoPro and later 12-hour infusion of the drug that required hospitalization. The difference in complications between the groups was not considered statistically significant.

"This study shows that the combination of delivering of stents through the wrist artery, while using a single dose of ReoPro, is extremely safe and allows even high-risk heart patients to go home the same day," Bertrand said.

Bertrand, whose hospital has been a pioneer in using the wrist-artery method of delivering stents, said the new study validates the method.

He said it also could give ReoPro an advantage over Aggrastat and Integrilin, which require long intravenous infusions and overnight hospitalizations after stenting procedures.