Doctors hopeful easier blood thinners are nearing

From the Associated Press:
A trio of experimental drugs has doctors hopeful that for the first time in decades, millions of people at risk of lethal blood clots may soon get easier treatment.

The first goal is a pill option for people who now need daily blood-thinning shots for weeks after knee or hip replacement surgery.

But the ultimate goal is an alternative to that old standby warfarin, also called Coumadin, the nation's most troublesome lifesaver because of side effects and restrictions its 2 million users face.

Now in late-stage testing in thousands of Americans are three pills that work to prevent blood clots in ways that promise to be less burdensome. One of the trio, Boehringer Ingelheim's Pradaxa, just began selling in Europe.

The drug research comes as Medicare is considering withholding payment from hospitals when at-risk patients develop clots in their veins, usually the legs — a common preventable cause of hospital deaths. The National Quality Forum has estimated that only about a third of patients who need protective blood thinners while hospitalized get them.

Known medically as a "deep vein thrombosis" or DVT, such a clot can kill quickly if it moves up to the lungs. There aren't good counts, but recent estimates suggest that about 900,000 people a year suffer a vein clot, and nearly 300,000 die. Being immobile for long periods, such as during hospitalizations or even long airplane flights, can trigger a clot. Vice President Cheney suffered one after a long trip last year. NBC correspondent David Bloom died of one in 2003 after spending days in a cramped military vehicle while covering the invasion of Iraq. ...more

Dutch stroke study urges greater anticoagulant use

From Reuters:
Dutch doctors called on Sunday for greater use of oral anticoagulants to prevent strokes in people with a common heart arrhythmia.

Atrial fibrillation (AF), a heart flutter, is dangerous because blood pools in the heart, forming clots that can lead to deadly strokes.

Current guidelines recommend that AF patients be treated with drugs to stop this happening, but many doctors are wary of using the anticoagulant pills because they are difficult to monitor and can lead to uncontrolled bleeding.

That physician caution may be costing lives, Ron Pisters and colleagues at the University Hospital Maastricht told the annual European Society of Cardiology congress. ...more

U.S. orders genetic data on blood-thinner risks

From Reuters:
Widely used blood thinner warfarin will come with new instructions explaining that people with certain genes may need a lower dose to take the drug safely, U.S. health officials said on Thursday.

The change is part of a move toward personalized medicine in which doctors tailor treatment based on genetic makeup, the Food and Drug Administration said.

Warfarin is sold by several generic makers and by Bristol-Myers Squibb under the brand name Coumadin. An estimated 2 million U.S. patients start taking the drug each year to prevent blood clots that may cause heart attacks and strokes.

Some patients, however, experience dangerous bleeding. Experts say about two in 100 patients taking warfarin will have a serious hemorrhage. Excessive bleeding from the drug is one of the most common prescription-related causes of emergency room visits, studies have shown. ...more

Genetic testing cited for blood thinner

From the Williston (NDak) Herald News Daily:
Federal health officials are stopping short of recommending genetic tests for patients on the blood-thinner warfarin, even though they have said such screenings could prevent thousands of complications each year.

"This means personalized medicine is no longer an abstract concept but has moved into the mainstream," the Food and Drug Administration‘s clinical pharmacology chief, Larry Lesko, said in announcing the label change.

The FDA has not changed its dosing recommendations for the drug, and tailoring the proper dosage remains largely a matter of trial and error.

Genetic testing can reveal which patients may require less of the drug and lead doctors to recommend doses closer to the lower end of the scale, FDA officials said. ...more