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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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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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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FDA Approves New Blood Thinner Eliquis

Dec. 31, 2012 -- The FDA has approved the blood thinner Eliquis to prevent stroke in people with atrial fibrillation.

AFib is the most common type of irregular heartbeat and affects about 3 million Americans.

People with AFib are about five times more likely to have a stroke.

Eliquis is approved only for use in people with AFib that is not caused by a heart valve problem. People with prosthetic heart valves should not take Eliquis.

In its approval, the FDA cited a clinical trial of Eliquis in more than 18,000 people with AFib.

The results showed that people who took Eliquis twice a day had 21% fewer strokes than those on the blood thinner warfarin.

AFib raises the risk of stroke because if the heart doesn’t beat strongly and regularly, blood can pool in the heart and become more likely to form clots.

“Blood clots in the heart can cause a disabling stroke if the clots travel to the brain,” says Norman Stockbridge, MD, PhD, of the FDA’s Center for Drug Evaluation and Research. “Anti-clotting drugs lower the risk of having a stroke by helping to prevent blood clots from forming.”

Eliquis is now the third new blood thinner to be approved as an alternative to warfarin since 2010. Pradaxa, produced by Boehringer Ingelheim, was approved in 2010, and Xarelto, marketed by Johnson & Johnson and Bayer AG, was approved in 2011.

The approval of Bristol-Myers Squibb and Pfizer’s Eliquis comes six months after the agency delayed its decision on the new blood-thinning drug.

Researchers say these new alternatives to warfarin are easier to take and are believed to be safer than warfarin, also known as Coumadin.

People taking warfarin must have their blood tested regularly because the drug can raise the risk of life-threatening bleeding.

Although researchers say people taking the new types of blood thinners do not have to be monitored as closely, the risk of life-threatening bleeding is still an issue.

There is no agent that can rapidly reverse the anti-clotting effect of Eliquis and the other new-generation blood thinners.

FDA says health care professionals should counsel people taking Eliquis and other blood thinners about the symptoms of possible bleeding, such as, paleness and fatigue.

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