An Explosion of New Anticoagulants

News from the World of Pharmacology

An Explosion of New Anticoagulants

There has been a lot of activity in the anticoagulant arena over the past year. Dabigatran (Pradaxa®), approved in October 2010, became the first orally available anticoagulant contender to compete with age-old warfarin, at least in the atrial fibrillation market. While dabigatran, a direct thrombin inhibitor, offers some advantages over warfarin, such as more predictable pharmacology (ie., minimal potential for pharmacokinetic, life style or dietary interactions or genetic variability), easier dosing options and little or no need for monitoring in most patients, it is still far from the perfect oral anticoagulant. Stomach upset and the requirement for b.i.d dosing threaten compliance and, in this case, poor compliance can result in treatment failure and thrombotic events. Conversely, in the case where the anticoagulant causes hemorrhage, as all anticoagulants can do, there is no antidote to turn to, like vitamin K (warfarin) or protamine (heparin).
Enter Xarelto® (rivaroxaban), an oral Factor Xa inhibitor approved in July 2011 for prevention of DVT following orthopedic surgery. Much like Pradaxa, Xarelto has more predictable pharmacology than warfarin and no requirement for monitoring. One potential advantage it offers over Pradaxa is once daily dosing. It is also less likely to cause GI distress; that's a big plus for compliance. So far, so good, right? Not so fast. Xarelto, unlike Pradaxa, is cleared through the cytochrome P450 system (CYP3A4) and, therefore, the possibility for drug interactions could complicate therapy. There is also no specific antidote if hemorrhage occurs.
Both drugs are actively looking to compete with each other's currently approved indication: Pradaxa is looking for approval for prevention of DVT following orthopedic surgery (RE-NOVATE, RE-MODEL) and, just this week, Xarelto got a favorable nod from an FDA advisory committee for approval in the atrial fibrillation arena (ROCKET-AF). Of course, both would like to get approval across the board for everything thrombosis...........
http://bit.ly/qbhH9L

FDA Advisory Committee Recommends Approval of Rivaroxaban for Stroke Prevention in Patients with Atrial Fibrillation

On September 8, 2011, an FDA advisory committee recommended approval of rivaroxaban (Xarelto – Janssen Pharmaceutical / Johnson & Johnson) for stroke prevention in patients with atrial fibrillation (Afib).  While this is good stroke prevention news for patients with Afib, it is important to note that, at this point, FDA has not approved rivaroxaban and it is not bound to follow the advisory committee’s recommendation. For more information, click here.

Until recently, warfarin has been the only oral blood thinner available for 60 years. National Blood Clot Alliance (NBCA) President, Randy Fenninger said that “we await to learn of FDA’s decision. The National Blood Clot Alliance, on behalf of its Afib constituents looks forward to other safe and effective blood thinners to prevent strokes as well as the prevention of DVT/PE in other patients at risk.”

Rivaroxaban was approved in July 2011 for patients with total hip or knee replacement to prevent DVT/PE.  Rivaroxaban is one of several new oral anticoagulants (blood thinners) developed in the last several years as an alternative to warfarin for the treatment of Afib. Dabigatran (Boehringer Ingelheim) is FDA approved and Apixaban (Bristol-Myers Squibb/Pfizer) study data will be submitted to FDA for review.

“We rely on FDA to make sure that any new drug is safe and effective for patient use,” said Jack Ansell, MD, Chair of NBCA’s Medical and Scientific Advisory Board.  Dr. Ansell added that “warfarin is often difficult for patients and doctors to manage, and other blood thinner options are needed for preventing stroke in Afib patients and for treating patients at risk for or with DVT/PE.”.... 

http://bit.ly/r3nAoc

Psoriasis May Increase Stroke Risk

Aug 17, 2011 | 4:18 PM ET | By Rachael Rettner, MyHealthNewsDaily Staff Writer

Credit: Christine Langer-püschel | Dreamstime

The skin condition psoriasis may increase the risk of stroke and atrial fibrillation, a condition in which the heart beats irregularly, a new Danish study says.
In some cases, patients with psoriasis had nearly 3 times the risk of experiencing these conditions compared with people without psoriasis. The risk was greater in patients with severe psoriasis.

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The findings add to a growing body of research linking psoriasis with heart and blood vessel problems, including an increased risk of heart attack and death from cardiovascular disease.
"In recent years, psoriasis has certainly taken the step from a disease affecting appearance to a systemic disease and cardiovascular risk factor," said study researcher Dr. Ole Ahlehoff, a cardiologist at Copenhagen University Hospital Gentofte.

Patients with psoriasis should be monitored for indicators of cardiovascular disease, including heart arrhythmias, Ahleoffsaid.

And these patients may be candidates for interventions that will reduce cardiovascular disease risk, including lifestyle modifications, such as quitting smoking and getting more exercise, and in some cases, medications, Ahlehoff said.

Future studies should investigate whether treating psoriasis reduces patients' cardiovascular disease risk, he said.

Psoriasis and the heart

Psoriasis is common and causes skin redness and irritation, according to the NationalInstitutes of Health. In those with the condition, skin cells rise to the skin's surface too quickly, which doesn't leave enough time for the old skin cells to fall off, leading to build up of dead skin cells. The condition may be triggered by abnormal signals from the body's immune system.

Ahlehoff and colleagues counted the cases of atrial fibrillation and ischemic stroke in the entire adult and adolescent population of Denmark — about 4.5 million people — from 1997 to 2006, using a national database. An ischemic stroke occurs when a blood vessel to the brain becomes blocked.

The researchers identified about 36,700 patients with mild psoriasis and about 2,800 with serve psoriasis during that time period.

Patients younger than 50 with psoriasis had about a 3-fold increased risk of atrial fibrillation, and a 2.8-fold risk of stroke, compared with those who didn't have psoriasis. Older patients and those with mild psoriasis had a smaller, but still significant, increase in their risk of stroke and atrial fibrillation.

The results held even after the researchers took into account factors that could affect the findings, including age, gender, medical treatment and procedures, and level of income.

Behind the link

Psoriasis patients are thought to be at increased risk for cardiovascular disease for two reasons, said Dr. Robert Kirsner, a professor of dermatology at the University of Miami Miller School of Medicine, who was not involved with the new study.

One is that, as a group, they tend to have more cardiovascular risk factors, including obesity, smoking and high lipid levels.

The other is that an increase in inflammation in the body links the conditions, Kirsner said.

Psoriasis is a chronic inflammatory disease, or a condition in which the immune system is in a constant state of alert, Ahlehoff said. This type of inflammation is also thought to play a role in stroke and atrial fibrillation, Ahlehoff said.

Kirsner said the study provides additional support for inflammation as being a factor in psoriasis that increases patients' vascular disease risk.
 http://bit.ly/pX5l3S

Dutch engineers make 'robot legs' for stroke patients

By Neil Bowdler Health reporter, BBC News

The LOPES therapeutic robot can do all or some of the walking for you

Continue reading the main story

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Scientists in the Netherlands are using robotic legs to try to improve the movement of stroke patients.

The prototype device is called the Lower-extremity Powered ExoSkeleton, or LOPES, and works by training the body and mind of a patient to recover a more natural step.
The machine is also being tested on spinal injury patients who have recovered some restricted movement in their legs.
It is hoped a commercial version could be made available to rehabilitation centres around the world as early as next year.
Feedback mechanism LOPES has been developed by engineers at the University of Twente in Enschede in the Netherlands over several years. Designed for the rehabilitation clinic, it is not a mobile device but supports the patient as they walk on a treadmill.
It can do all the walking for the patient, or it can offer targeted support in either one leg or with one element of the walking process. The machine can also detect what the patient is doing wrong.
"For instance, some people cannot lift their foot up appropriately," explains Dr Edwin van Asseldonk, who is working on the project. "What this device does is it senses that the foot is not lifting properly.
"It then compares it with a reference pattern and then exerts a force or torque to assist that subject in doing it."

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Dr Edwin van Asseldonk explains what LOPES can do

Petra Hes is one of those testing the device. She suffered a stroke aged just 17. Years of physiotherapy have helped, but she still has what is known as a "drop foot", which means she cannot lift and flex her left foot in the way she once did, or even remember how to do so......
http://bbc.in/oxiDL3

Stroke victim sues Paradise hospital

PARADISE -- It's been nearly two years since Jim Livingston had a stroke and was treated at Feather River Hospital. While he's made progress at recovering, he still speaks haltingly. The stroke also caused him to lose his ability to read and write although that has come back a little, he said in a phone interview this week.
On Sept. 13, Livingston filed suit against the hospital, claiming he was given a drug that is not approved for treating stroke and was not the one doctors in the emergency room ordered him to have....  http://bit.ly/qB1HHm

New Study Shows Soy Protein Consumption Reduced Progression of Clogged Arteries in Women Within Five Years of Menopause

This Large Scale, First-of-a-Kind Study Will Be Published in the November Issue of 'Stroke'

ST. LOUIS, MO, Sep 22, 2011 (MARKETWIRE via COMTEX) -- A new study, which Solae provided product for, will be published in the November 2011 issue of Stroke that reveals some promising data on the positive effects of soy protein reducing the progression of clogged arteries in women who were within five years of menopause. This study was the largest and longest randomized controlled human study conducted to-date that directly investigated the efficacy of isolated soy protein consumption on the progression of atherosclerosis (lipid deposition in the artery walls).

"These results are consistent with what we have learn..... http://bit.ly/plCv78

Scientists identify 70 genes to help stroke patients

Healthcare News
22/09/2011
Scientists have detected some 70 genes which could help stroke patients to recover.
A new discovery could aid the recovery of individuals who have experienced a stroke or spinal cord injury.

Scientists identified 70 genes which promote axon re-growth, helping to regenerate nerves, following stroke or spinal injury. .... http://bit.ly/nmG5Qh

Ultrasound of Neck Predicts Who Will Have a Stroke

Aug. 17, 2011 -- Two noninvasive imaging tests may help determine which people with a narrowing of arteries in the neck will need surgery to reduce their future risk of stroke, a study suggests.
A narrowing of the carotid arteries in the neck is known as asymptomatic carotid stenosis (ACS). "Asymptomatic" means the patient does not experience any symptoms.
Carotid arteries in the neck deliver blood to the brain. They typically become narrowed when plaques build up in the inner lining of the arteries.
There is some uncertainty within the medical community on how to best identify people with ACS who are at high risk for stroke and need surgery or stenting to open their carotid arteries as opposed to treatment with medication.
In a  two-year study of 435 people with severe ACS, researchers used ultrasound to assess the quality and composition of the plaque in the carotid arteries and a Doppler ultrasound test to look for the presence of tiny blood clots or particles called microemboli that may break off from the arteries and travel to the brain, causing stroke.
The study is published in Neurology.

http://bit.ly/nyNi9i

battling progressive aphasia,

The former premier has been battling progressive aphasia, a form of dementia which affects his speech, reading and writing. However, they are happy to have their support for Mar known.

“We’ve spent a great deal of time with Gary and his wife over the years,” said Colleen. “He’s a good man, we’re glad to support him.”
Mar is pleased Klein is backing his campaign, a spokesman said.
“Gary is honoured Ralph would give him his endorsement,” said Mark Kastner. “He learned many valuable lessons from Ralph in the past including listening to people and fiscal accountability.”
Getty, meanwhile, said backing Horner was a natural choice given the long relationship between the families.

Read more: http://www.calgaryherald.com/Getty+backs+Doug+Horner+Ralph+Klein+endorses+Gary+Tory+leadership+race/5264322/story.html#ixzz1YM3fG296

 

http://bit.ly/p47WmV

Depression may increase stroke risk in women

Depression may boost women's risk of stroke, according to a new study.

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Among study participants, those who'd had depression were 29 percent more likely to suffer a stroke over a six-year period.
And women who took an anti-depressant medication — especially a selective serotonin reuptake inhibitor (SSRI) — had a 39 percent increased risk of stroke, the study said. Examples of these drugs include Prozac, Zoloft and Celexa.
The researchers said they do not think anti-depressants cause the increased stroke risk; rather, the connection exists because those who take these medications may have more severe depression, said study researcher Dr. Kathryn Rexrode, an associate physician at Brigham and Women's Hospital in Boston.....
http://on.today.com/qVQBah

Lower stroke risk found from eating apples and pears

submitted by Kathleen Blanchard RN on 2011-09-18

More about:

• Stroke
• Current News

If you're looking for a natural and tasty way to protect from stroke, new research suggests apples and pears might be good preventive medicine.

First study shows color of fruit may help prevent stroke

The health benefits of eating a diet rich in fruits and vegetables is well known, but the study is the first to discover that eating fruit with a white edible portion could lower stroke risk by 52 percent. Another recent study shows potassium, found in abundance in bananas, can reduce the chances of stroke.
Researchers from Wageningen University in the Netherlands published the finding in Stroke: Journal of the American Heart Association.
For their study, the researchers classified fruits and vegetables according to their color group, which also indicates different classes of phytochemicals that have been studied for their impact on promoting good health.
Lettuce, cabbage and green leafy vegetables, red and purple colors, citrus fruits of the orange and yellow variety, and white colors of fruits were all studied by the researchers. Fifty-five percent of the white fruits were apples and pears.
The findings showed a 9 percent reduction in stroke risk for every 25 grams of apples, pears or white vegetable consumption added to the daily diet. The participants were followed for 10 years. Dietary intake was tracked using food frequency questionnaires.
According to Linda M. Oude Griep, M.Sc.,
"To prevent stroke, it may be useful to consume considerable amounts of white fruits and vegetables. For example, eating one apple a day is an easy way to increase white fruits and vegetable intake.”
However, other fruits and vegetable color groups may protect against other chronic diseases. Therefore, it remains of importance to consume a lot of fruits and vegetables.
The study doesn’t show conclusively that apples and pears can lower stroke risk. The authors suggest more studies. People who eat a diet rich in fruits and vegetables may also practice other healthier lifestyle habits, accounting for the finding.
Apples, pears and other fruits in vegetables are rich in fiber, vitamins, minerals and other beneficial health compounds. The study suggests apples, pears and other white fruits and vegetables may be good medicine for stroke prevention.
Stroke, AHA journal: doi: 10.1161/STROKEAHA.110.611152
“Colors of Fruit and Vegetables and 10-Year Incidence of Stroke”
Linda M. Oude Griep et al.
Image credit: morguefile