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Findings Are Mixed on Use of Clot-Busting Drugs in the Elderly

May 22, 2000|THOMAS H. MAUGH II

Clot-busting drugs such as tPA have proved a lifesaver in the treatment of heart attacks and strokes--in young and middle-age adults, that is. For elderly patients, they may actually be life threatening.

The clinical trials of tPA, as with other new drugs, left out children and the elderly. Researchers have been able to determine the drugs' effects on these groups only by looking at patients after the fact. As in similar cases, that provided a surprise.

Dr. David R. Thiemann of Johns Hopkins University and his associates studied data on 7,864 Medicare patients ages 65 to 86 who arrived at hospitals with a heart attack and who were candidates for clot-dissolving therapy. There were 5,191 patients ages 65 to 75 and 2,673 patients 76 to 86.

The team reported in Tuesday's issue of the journal Circulation (http://circ.ahajournals.org) that 6.8% of the patients in the younger group who received the clot-busting drug died, compared with 9.8% of those who did not receive it. The findings were reversed in the older group, however: 18% of those treated with the drug died, compared with 15.4% of those who were not treated with it.

Antidepressant May Aid Women's Sexual Arousal

Physicians rarely talk about wonder drugs anymore, but a small study indicates researchers may have found one in bupropion, an antidepressant that can help women both stop smoking and possibly have a better sex life.

As many as 20% of American women suffer from a syndrome called hypoactive sexual desire disorder, which means, simply, that they rarely get aroused, have few sexual fantasies and aren't often interested in sexual activity.

Dr. R. Taylor Segraves of Case Western Reserve University School of Medicine in Cleveland and his colleagues studied 66 non-depressed women, ranging from 23 to 65 years old, who had been hyposexual for an average of six years. Each of the women received a placebo for four weeks and then 51 received bupropion for eight weeks.

Segraves reported Wednesday at a Chicago meeting of the American Psychiatric Assn. that, on average, the number of sexual arousals doubled when the women were taking bupropion, as did the number of sexual fantasies and the incidence of interest in sexual activities. Nearly 40% of the women given the drug reported being satisfied with their sexual desire at the end of the study, while 100% were dissatisfied before starting treatment. Bupropion is marketed as Wellbutrin for treating depression and as Zyban for stopping smoking. The study was funded by Glaxo Wellcome Inc., which sells Wellbutrin.

Possible Relief for Post-Cancer Hot Flashes

Another antidepressant may provide the first effective treatment for hot flashes in survivors of breast cancer, researchers from Georgetown University Medical Center reported Thursday at the same American Psychiatric Assn. meeting.

As many as 55% of breast cancer survivors suffer from hot flashes in the aftermath of their treatment. Many fear taking estrogen to relieve the symptoms because of the risk that it might cause a relapse of their cancer. Dr. Vered Stearns of Georgetown found there is an alternative for such women.

Stearns and his colleagues gave 31 women in the study a placebo for one week and then the antidepressant paroxetine for five weeks. Two-thirds of the women reported having half as many hot flashes while taking the drug, and three-quarters said the hot flashes they did have were less severe. Twenty-five of the women chose to continue taking the drug after the study was completed. Paroxetine, marketed as Paxil, is also used for relieving social anxiety.

Parkinson's Team Backs New Treatment

The new drug ropinirole should replace levodopa as the first-line treatment for Parkinson's disease because it has fewer side effects, researchers reported Thursday in the New England Journal of Medicine (http://www.nejm.org).

The question of which drug to use to control tremors and shaking early in the course of the disease has long been a contentious one among gerontologists, but the new results may resolve the dispute.

A multinational team in France studied 179 patients who received ropinirole and 89 who received levodopa as their first treatment for the disease. After five years, 45% of those receiving levodopa had developed movement disorders called dyskinesia--severe twitching and shaking--compared with 20% of those receiving the new drug. All other health measures were equivalent for the two drugs.

Arthritis Drug May Help Preemie Brains Develop

Indomethacin, a drug used for treating arthritis in adults, can help protect brain development in infants born prematurely, according to Yale researchers.

Premature infants suffer from a variety of problems, including a 10- to 15-point IQ loss compared with full-term infants. That deficit is caused, at least in part, by bleeding in the brain, and the Yale team hoped that indomethacin would reduce the bleeding.

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