Pricey New Blood Thinner Might Be Safer for Leg Clots

In trial, Eliquis worked as well as warfarin but with less risk of bleeding

By Brenda Goodman

HealthDay Reporter

MONDAY, July 1 (HealthDay News) -- The new pill Eliquis prevents dangerous blood clots in the legs and lungs as well as standard therapy, though with less risk of serious bleeding, a new study shows.

The research, published online July 1 in the New England Journal of Medicine, may point doctors toward a simpler, if more costly, way to prevent repeat blood clots in patients at risk for venous thromboembolism.

Venous thromboembolism includes two related conditions: deep vein thrombosis (DVT) and pulmonary embolism. Together, these conditions hospitalize more than 500,000 adults each year in the United States, according to the government's National Hospital Discharge Survey.

In DVT, a blood clot forms in the deep veins of the leg, causing swelling, redness, warmth and pain. If the blood clot breaks free, it can travel and lodge near the brain, heart or another vital organ, causing severe damage. If a clot blocks a blood vessel in the lungs, it's a life-threatening emergency called pulmonary embolism (PE). PEs are the third leading cause of cardiovascular death after heart attacks and strokes.

Blood clots in veins can happen without warning, but certain factors increase a person's risk including obesity, high blood pressure, long-distance travel, air pollution, cigarette smoking, pregnancy or recent surgery or injury.

Once a person has had one venous clot, they're more likely to get another, so doctors will often prescribe medication to lower the risk.

For years, the medication doctors relied on to prevent blood clots was a drug called warfarin, which is also sold under the brand name Coumadin.

Warfarin works well, but it's also tricky to take. Patients on the drug need regular blood tests -- these can be weekly at the start of treatment -- to make sure they're taking the right dose. And the dose can change from day to day or week to week. There are also a number of foods and drugs that can interact with warfarin, interfering with its effectiveness.

"It's really challenging for elderly patients to get it all right," said senior study author Dr. Jeffrey Weitz, a professor of medicine at McMaster University in Ontario, Canada.

In December, the U.S. Food and Drug Administration approved the drug Eliquis. Like warfarin, Eliquis prevents blood clots, but it works in a slightly different way than the older medication. It also doesn't require regular blood tests or changing dosages, making it much easier to manage.

One drawback of Eliquis is its price. Mail-order pharmacies charge between $250 and $275 for a 30-day supply of the medication in the United States, according to the website pharmacychecker.com. Warfarin, on the other hand, is $4 for a 30-day supply at stores like Target and Walmart. That means that one Eliquis pill costs about as much as an entire month's supply of warfarin.

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Study Pinpoints Women at Risk for Blood Clots From Pregnancy

Factors include age, disease history and weight

By Robert Preidt

HealthDay Reporter

TUESDAY, April 2 (HealthDay News) -- Several factors that increase the risk of blood clots in women during or after pregnancy are outlined in a large new study.

Women who were older than 35, who were overweight or obese, or who smoked were at somewhat higher risk of developing blood clots during pregnancy. Medical complications such as pre-existing diabetes, varicose veins and inflammatory bowel disease were also associated with increased risk.

The findings could help doctors identify at-risk women and take measures to prevent them from developing blood clots, which can be dangerous and potentially deadly if they break free and travel to areas such as the heart, brain or lungs.

For the study, researchers analyzed data from nearly 400,000 pregnancies that occurred between 1995 and 2009.

Among new mothers, being obese was associated with a fourfold increased risk of developing a blood clot. The risk was two times higher than normal among those who had a cesarean delivery, a premature birth, bleeding in pregnancy or had given birth three or more times, according to the study, which appeared April 2 in the journal Blood.

Women who had a stillbirth were six times more likely to develop a blood clot, formally known as venous thromboembolism (VTE).

"We believe the strong association between stillbirths and premature births and [blood clots] in particular is a finding of real importance that has received only limited attention to date," study leader Dr. Matthew Grainge, of the School of Community Health Sciences at the University of Nottingham, in England, said in a university news release. "[Stillbirths and premature births] are not currently incorporated in the guidelines for risk assessment for [blood clots] and, if they were, then many cases associated with those risk factors could potentially be prevented."

Blood clots affect about one or two pregnancies per 1,000, according to the news release. Despite being rare, blood clots are a leading cause of death in expectant and new mothers in developing countries.

"Preventative measures for [blood clots], such as a daily dose of the blood thinner heparin, may not be cost effective or safe and are therefore only recommended for women who are considered high risk," Grainge said. "However, there is currently inconsistency and disagreement over the factors that put women in that high-risk category, and we hope this research will provide clinicians with valuable new information."

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Aspirin Equals Pricier Blood Thinner for Preventing Clots: Study

After hip replacement, no disadvantage found for the low-cost treatment

By Serena Gordon

HealthDay Reporter

TUESDAY, 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.

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Study Probes Use of Filter Device to Stop Deadly Blood Clots

Title: Study Probes Use of Filter Device to Stop Deadly Blood Clots
Category: Health News
Created: 3/18/2013 4:35:00 PM
Last Editorial Review: 3/19/2013 12:00:00 AM

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New Blood Thinner Beats Older Drug for Vein Clots: Study

Title: New Blood Thinner Beats Older Drug for Vein Clots: Study
Category: Health News
Created: 2/20/2013 6:36:00 PM
Last Editorial Review: 2/21/2013 12:00:00 AM

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Some Migraines Linked to Heart Attack, Blood Clots

Jan. 15, 2013 -- Women who have migraine with aura may have a higher risk of heart attacks, and they may face a higher risk of dangerous blood clots if they use certain hormonal contraceptives.

Those are the findings from two newly published studies to be presented in March at the 65th annual meeting of the American Academy of Neurology in San Diego.

Migraine with aura refers to migraine headaches that are preceded by visual or other sensory symptoms such as flashing lights, blind spots, smell distortion, numbness, or tingling of the hands and face.

About 1 in 4 people with migraines have this type of migraine.

In the first study, having migraine with aura, but not regular migraines, was a risk factor for heart attacks among middle-aged and older women.

The analysis included data on close to 28,000 women enrolled in the ongoing Women’s Health Study.

During 15 years of follow-up, about 1,400 women who had migraine with aura were identified, and there were 1,030 heart attacks, strokes, or deaths from cardiovascular causes.

After having high blood pressure, having migraine with aura was found to be the second strongest contributor to heart attack and stroke risk, according to researcher Tobias Kurth, MD, of Brigham and Women’s Hospital in Boston and the French National Institute of Health.

Migraine with aura was found in the study to be a bigger risk factor for these cardiovascular conditions than having a family history of early heart disease or having diabetes or being obese or a smoker.

“We have known that migraine with aura is associated with cardiovascular risk,” neurologist and migraine specialist Noah Rosen, MD, says. “What is striking about this study is that it shows just how big this risk is.”

Rosen directs the Headache Center at the Cushing Neuroscience Institute, of the North Shore-LIJ Health System in Manhasset, N.Y.

In the second study, women with migraines who used combined hormonal contraceptives had a higher risk for dangerous deep vein blood clots, and the risk was highest in women with migraine with aura. Combined hormonal contraceptives contain both estrogen and progestin.

While there was a suggestion that newer-generation combined hormonal contraceptives might carry a greater risk for blood clots, researcher Shivang Joshi, MD, of Boston’s Brigham and Women’s Faulkner Hospital, says the difference among users of newer- and older-generation hormonal contraceptives was not that great.

Joshi and colleagues examined the impact of migraine type and combined hormonal contraception type on blood clot risk using data from a health insurance registry that included women enrolled between 2001 and 2012.

The researchers identified around 145,000 women who used combined hormonal contraceptives, including 2,691 who had migraines with aura and 3,437 who had migraines without aura.

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