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By Serena Gordon
HealthDay ReporterTUESDAY, June 4 (HealthDay News) -- Aspirin appears to be just as good as more expensive, more potent blood-thinning medication for preventing blood clots after hip replacement surgery, according to new research.
People who get artificial hips are at risk of serious blood clots, such as deep vein thrombosis and pulmonary embolism, after the surgery. To prevent them, doctors usually prescribe blood-thinning (anticoagulant) medications, such as low-molecular-weight heparin, which is given by injection, or the newer drug, rivaroxaban (brand name Xarelto), a pill.
But that old medicine-cabinet standby, aspirin, also has blood-thinning properties. And the Canadian researchers wondered if this simple, inexpensive drug could also prevent blood clots after a major surgery.
They compared the drugs for four weeks, following 10 days of treatment with heparin immediately post-surgery.
The investigators found the two medications were similarly effective and safe. Where the medicines differ significantly is in cost.
"Low-molecular-weight heparin and the newer blood thinner, Xarelto, are similarly priced; they're several hundred-fold more expensive than aspirin," said the study's lead author, Dr. David Anderson, a professor and head of the department of medicine at Dalhousie University in Halifax, Nova Scotia.
"Given the low cost of aspirin and its convenience, it's a reasonable alternative to low-molecular-weight heparin when used in the manner designed in this trial," said Anderson.
Another expert said the study results, published in the June 4 issue of the Annals of Internal Medicine, support previous observations. "After initial treatment with an anticoagulant, then giving aspirin to these patients for the prevention of [serious blood clots] is as good," said Jawed Fareed, professor of pharmacology and pathology and director of the hemostasis and thrombosis research unit at Loyola University Medical Center in Maywood, Ill.
For the study, Anderson and his colleagues recruited 778 patients undergoing elective hip replacement surgery between 2007 and 2010. All received 10 days of heparin (dalteparin) following surgery. After that, they were randomized into one of two groups for four more weeks of blood-thinning therapy. Half continued receiving heparin injections, while the other half took low-dose (81 milligrams) aspirin daily.
Five people on dalteparin and one on aspirin developed a blood clot. The absolute difference between the two therapies was 1 percent. Bleeding events serious enough to require treatment occurred in five people on dalteparin, and two on aspirin.
Anderson said the difference in bleeding events wasn't statistically significant, but there was a trend toward aspirin being the safer alternative. However, it's too soon to tell definitively whether aspirin might cause less bleeding, he said.
Anderson said the researchers had to stop the study early because they weren't able to recruit the desired number of patients. While the study was under way, Xarelto was approved, and because it's a pill instead of an injectable like dalteparin (brand name Fragmin), it became difficult to find volunteers for the multiple injection part of the trial.
By Serena Gordon
HealthDay ReporterWEDNESDAY, June 5 (HealthDay News) -- Using an immune-suppressing medication and adult stem cells from healthy donors, researchers say they were able to cure type 1 diabetes in mice.
"This is a whole new concept," said the study's senior author, Habib Zaghouani, a professor of microbiology and immunology, child health and neurology at the University of Missouri School of Medicine in Columbia, Mo.
In the midst of their laboratory research, something unanticipated occurred. The researchers expected that the adult stem cells would turn into functioning beta cells (cells that produce insulin). Instead, the stem cells turned into endothelial cells that generated the development of new blood vessels to supply existing beta cells with the nourishment they needed to regenerate and thrive.
"I believe that beta cells are important, but for curing this disease, we have to restore the [blood vessels]," Zaghouani said.
It's much too early to know if this novel combination would work in humans. But the findings could stimulate new avenues of research, another expert says.
"This is a theme we've seen a few times recently. Beta cells are plastic and can respond and expand when the environment is right," said Andrew Rakeman, a senior scientist in beta cell regeneration at the Juvenile Diabetes Research Foundation (JDRF). "But, there's some work still to be done. How do we get from this biological mechanism to a more conventional therapy?"
Results of the study were published online May 28 in Diabetes.
The exact cause of type 1 diabetes, a chronic disease sometimes called juvenile diabetes, remains unclear. It's thought to be an autoimmune disease in which the body's immune system mistakenly attacks and damages insulin-producing beta cells (found in islet cells in the pancreas) to the point where they no longer produce insulin, or they produce very little insulin. Insulin is a hormone necessary to convert the carbohydrates from food into fuel for the body and brain.
Zaghouani said he thinks the beta cell's blood vessels may just be collateral damage during the initial autoimmune attack.
To avoid dire health consequences, people with type 1 diabetes must take insulin injections multiple times a day or obtain continuous infusions through an insulin pump. It's estimated that 3 million U.S. children and adults have the disease, which increased by almost one-quarter in Americans under age 20 between 2001 and 2009.
Zaghouani and his colleagues previously tested a drug called Ig-GAD2 that would destroy the immune system cells responsible for destroying the beta cells. The drug worked well to prevent type 1 diabetes, but it didn't work as a therapy when type 1 diabetes was more advanced.
"This made us question whether there were enough beta cells left when the disease is advanced," said Zaghouani. After conducting bone marrow transplants, the researchers came to a surprising conclusion. "The bone marrow cells did go to the pancreas, but they didn't become beta cells; they became endothelial cells," he said. "So, the problem wasn't a lack of beta cells or their precursor, the problem was that the blood vessels that irrigate the islet cells are damaged. That was a very novel and intriguing finding."
By Steven Reinberg
HealthDay ReporterWEDNESDAY, June 5 (HealthDay News) -- Older people who suffer from a type of irregular heartbeat called atrial fibrillation may also be more likely to experience mental declines sooner, a new study suggests.
"Problems with memory and thinking are common for people as they get older," said lead researcher Evan Thacker, a statistician in the department of epidemiology at the University of Alabama at Birmingham. "Our study shows that, on average, these problems may start earlier or get worse more quickly in people who have atrial fibrillation. This means that heart health is an important factor related to brain health."
As with other such studies, this one established only an association between atrial fibrillation and mental decline, not a direct cause-and-effect relationship.
That's why the next step is to find out why people with atrial fibrillation start to struggle with memory and thinking sooner, Thacker said.
There are at least two possibilities, he said. First, people with atrial fibrillation may have small blood clots form in the heart that then become lodged in the brain.
"These may be too small to cause noticeable strokes, but may over time cause small damage to the brain that would eventually lead to mental decline," Thacker said.
Second, people with atrial fibrillation may simply have less blood flowing to the brain, he said.
"This could result in the brain not getting as much oxygen and nourishment as it needs, which could lead to damage over time that would result in mental problems," Thacker said.
"Currently, we do not know whether either of these two possibilities actually occurs," he said. "We would like to study it using brain imaging technology to learn more about what is happening in the brains of people with atrial fibrillation."
Eventually, if doctors and researchers can discover why people with atrial fibrillation show accelerated mental decline, they might be able to learn how to prevent the problem, Thacker said.
The report was published online June 5 in the journal Neurology.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said, "Atrial fibrillation is present in close to 3 million men and women in the United States and increases the risk of stroke fivefold compared to the general population."
In addition to the marked increase in the risk of stroke, more recent research suggests that atrial fibrillation is associated with an increased risk of mental decline and dementia, he said.
"Repetitive, small subclinical strokes in patients with atrial fibrillation may account for these findings," Fonarow said.
He said giving blood thinners to patients with atrial fibrillation is standard care to prevent clots in the heart from migrating to the brain.
Putting these patients on anticoagulants, such as warfarin or one of the newer therapies, will "likely be effective in not only reducing the risk of stroke, but also reducing the significant risk of mental decline and dementia," he said.
Our friends at Active.com cull the best races for you across the country, and every month, we'll be sharing our favorite one!
The Race: Divas Half Marathon & 5K Series
The Location: North Myrtle Beach, SC
The Date: April 28, 2013
Are you ready for a girls' weekend? From the east to the west coast, run like a DIVA with other strong and beautiful women. Dress up at the feather boa station, stop by the tiara stop, and receive a rose from a handsome man at the finish line. Make sure to toast your accomplishments with some bubbly at the post-race dance party. Want in? Sign up now!
--Fara Rosenzweig, Active.com
Image Credit: Diva Half Marathon & 5K Series
