What's new in the other general journalsBMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7497.927 (Published 21 April 2005) Cite this as: BMJ 2005;330:927
- Alison Tonks, associate editor ([email protected])
Abciximab reduces mortality in patients having a primary angioplasty for heart attack
The latest meta-analysis of abciximab for patients with heart attack shows that it can reduce the risk of reinfarction across the board (2.1% v 3.3%, P < 0.001; figure) but reduces mortality only when combined with primary angioplasty, not fibrinolysis. Among patients who had primary angioplasty, mortality six to 12 months after treatment was 4.4% in the abciximab groups compared with 6.2% among controls (odds ratio 0.69,95% CI 0.52 to 0.92, P = 0.01). That translates to a number needed to treat of 55.6 to prevent one death.
The authors analysed 11 randomised trials including more than 27 000 patients with heart attack and ST segment elevation. Most of them (85.3%) were given fibrinolytic drugs. Abciximab made nodifference to short or long term mortality in these patients, but it did increase the risk of serious bleeding (5.2% v 3.1%, P < 0.001).
Abciximab reduces platelet aggregation by inhibiting glycoprotein IIb/IIIa. It's known to cause bleeding so patients having abciximab are usually given only half the recommended dose of fibrinolytic agent. All three fibrinolysis trials in this review adopted this strategy, but it wasn't enough to prevent a clear increase in the risk of serious bleeding. These findings combined with a neutral effect on mortality probably mean doctors should stop using abciximab in patients having fibrinolysis, say the authors.
JAMA 2005;293: 1759-65
Combined vaccine less effective than single meningitis C vaccine
A new combined vaccine against Streptococcus pneumoniae and group C Neisseria meningitidis has disappointed researchers in a randomised trial done in the United Kingdom. The vaccine, which was developed in response to overcrowded immunisation schedules, did not protect children as well as the single meningitis C vaccine. Worse, the combined vaccine reduced infants' immunological responses to other vaccines including diphtheria and Haemophilus influenzae type B (mean concentrations of antibodies against Hib 2.11 μg/ml in the combined vaccine …
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