For your doctors consultation, do not do anything on your own.
http://www.docguide.com/aspirin-still-overprescribed-stroke-prevention-atrial-fibrillation?
Aspirin is still overprescribed for stroke prevention in atrial
fibrillation (AF) despite the potential for dangerous side effects,
according to a study published in the American Journal of Medicine.“The
perception that aspirin is a safe and effective drug for preventing
strokes in AF needs to be dispelled,” said lead author Gregory Y.H. Lip,
MD, University of Birmingham, Birmingham, United Kingdom. “If anything,
you could say that giving aspirin to patients with AF is harmful
because it is minimally or not effective at stroke prevention, yet the
risk of major bleeding or intracranial haemorrhage is not significantly
different to well-managed oral anticoagulation.”
“All the contemporary guidelines say that aspirin should not be used
for the prevention of stroke in patients with AF,” he added”. And yet
our study shows that aspirin is still overprescribed in these patients.”
Prevention of strokes in patients with AF is based on identification
of risk factors. Patients with no stroke risk factors (ie, CHA2DS2-VASc
score of 0 in males or 1 in females) are considered low-risk and do not
need any antithrombotic drugs. Patients with 1 or more risk factors
should be offered effective stroke prevention, and thus be given an oral
anticoagulant. The use of aspirin, either alone or in combination with
an oral anticoagulant, is not recommended.
The study provides the most up-to-date picture of European
cardiologists’ prescribing of antithrombotic treatment, which includes
oral anticoagulation therapy (warfarin and the novel oral
anticoagulants) and antiplatelet drugs (mainly aspirin). The data are
from the EORP Atrial Fibrillation General Pilot Registry of more than
3,100 patients in 9 countries.
Overall the study found that the use of oral anticoagulants has
improved over the last decade since the last Euro Heart Survey was
performed. Where oral anticoagulation was used, most patients (72%) were
prescribed warfarin and just 8% were prescribed a new oral
anticoagulant.
“Novel oral anticoagulant uptake is still a bit low, probably because
of differences in regulatory approval, costs and access to drugs in
different countries,” said Dr. Lip. “But the main point is that overall
oral anticoagulant uptake as a whole has improved in the last 10 years.”
Aspirin was commonly prescribed, either alone or in combination with
an oral anticoagulant, when patients had myocardial infarction or
coronary artery disease. The strongest reason to prescribe both drugs
was coronary artery disease, which increased the use of combined therapy
by more than 8-fold.
“Aspirin is still overused for stroke prevention in AF,” said Dr.
Lip. “ESC guidelines say concomitant aspirin should not be given to
anticoagulated patients with AF with stable vascular disease. The
combination of drugs does not reduce cardiovascular events and stroke
but does increase the risk of bleeding.”
Another worrying finding was that oral anticoagulants were
under-prescribed in elderly patients, with aspirin alone more commonly
prescribed.
“Elderly patients are at the highest risk for stroke and yet they are
given aspirin which is not recommended and potentially harmful,” said
Dr. Lip. “There is a perception that elderly patients do not do well on
anticoagulation. But a number of studies now, including BAFTA, have
shown that in elderly patients warfarin is far superior to aspirin in
preventing stroke.”
Patients with paroxysmal AF were less likely to receive oral anticoagulation compared with patients with permanent AF.
“Cardiologists are continuing to under-prescribe anticoagulation in
paroxysmal AF and the belief that these patients are at less risk is
another myth,” said Dr. Lip. “ESC guidelines say that AF patients with
stroke risk factors should receive oral anticoagulation irrespective of
the type of AF. Our study of antithrombotic prescribing by cardiologists
reveals a positive trend of increasing oral anticoagulant use. But
worrying misconceptions and practices remain regarding aspirin,
treatment of the elderly and paroxysmal AF.”
SOURCE: European Society of Cardiology
Showing posts with label anti-thrombotic. Show all posts
Showing posts with label anti-thrombotic. Show all posts
Monday, February 10, 2014
Thursday, May 10, 2012
Blood Clot Prevention In A Dietary Supplement
Not fully tested yet, so don't jump the gun.
http://www.medicalnewstoday.com/releases/245153.php
A compound called rutin, commonly found in fruits and vegetables and sold over the counter as a dietary supplement, has been shown to inhibit the formation of blood clots in an animal model of thrombosis.
These new findings, led by investigators at Beth Israel Deaconess Medical Center (BIDMC) and published in the on-line issue of The Journal of Clinical Investigation (JCI), identify a novel strategy for preventing thrombosis, and help pave the way for clinical testing of this popular flavonoid as a therapy for the prevention and treatment of stroke and heart attack, as well as deep venous thrombosis (DVT) and pulmonary embolism.
"It's not always fully appreciated that the majority of Americans will die as the result of a blood clot in either their heart or their brain," says senior author Robert Flaumenhaft, MD, PhD, an investigator in the Division of Hemostasis andThrombosis at BIDMC and Associate Professor of Medicine at Harvard Medical School. "Approximately half of all morbidity and mortality in the United States can be attributed to heart attack or stroke."
The study focused on protein disulfide isomerase (PDI) which is found in all cells. Investigators in BIDMC's Division of Hemostasis and Thrombosis had previously shown that PDI is rapidly secreted from both platelets and endothelial cells during thrombosis, when a clot forms in a blood vessel, and that inhibition of PDI could block thrombosis in a mouse model.
"This was a transformative and unanticipated finding because it identified, for the first time, that PDI is secreted from cells in a live animal and is a potential target for preventing thrombosis," says Flaumenhaft. However, because intracellular PDI is necessary for the proper synthesis of proteins, the scientists had to identify a specific compound that could block the thrombosis-causing extracellular PDI - without inhibiting the intracellular PDI.
They began by conducting a high-throughput screen of a wide array of compounds to identify PDI inhibitors. Among the more than 5,000 compounds that were screened, quercetin-3-rutinoside (rutin) emerged as the most potent agent. "Rutin was essentially the champion compound," says Flaumenhaft.
A bioflavonoid that is naturally found in many fruits, vegetables and teas including onions, apples and citrus fruits, rutin is also sold as an herbal supplement, having received a special designation for safety from the U.S. Food and Drug Administration (FDA). Surprisingly, studies of the rutin molecule demonstrated that the same part of the molecule that provides rutin with its ability to inhibit PDI also prevents the compound from entering cells. "That finding explained how this compound can be both a potent inhibitor of PDI and a safe food supplement," says Flaumenhaft. "Our next questions were, 'Is this compound anti-thrombotic? Can it prevent blood clots?'"
The team went on to test rutin in a mouse model of thrombosis. Because they knew that humans would be taking rutin in pill form, they included studies in which the compound was administered orally and determined that it successfully retained its anti-thrombotic properties when it was metabolized following oral ingestion.
"Rutin proved to be the most potently anti-thrombotic compound that we ever tested in this model," says Flaumenhaft. Of particular note, rutin was shown to inhibit both platelet accumulation and fibrin generation during thrombus formation. "Clots occur in both arteries and in veins," explains Flaumenhaft. "Clots in arteries are platelet-rich, while those in veins are fibrin-rich. This discovery suggests that a single agent can treat and prevent both types of clots."
Even with the use of existing anti-clotting therapies, such as aspirin, clopidogrel (Plavix) and warfarin (Coumadin), each year there are approximately 400,000 recurrent episodes among patients who previously experienced a stroke or heart attack, says Flaumenhaft.
"A safe and inexpensive drug that could reduce recurrent clots could help save thousands of lives," he adds. "These pre-clinical trials provide proof-of-principle that PDI is an important therapeutic target for anti-thrombotic therapy, and because the FDA has already established that rutin is safe, we are poised to expeditiously test this idea in a clinical trial, without the time and expense required to establish the safety of a new drug."
http://www.medicalnewstoday.com/releases/245153.php
A compound called rutin, commonly found in fruits and vegetables and sold over the counter as a dietary supplement, has been shown to inhibit the formation of blood clots in an animal model of thrombosis.
These new findings, led by investigators at Beth Israel Deaconess Medical Center (BIDMC) and published in the on-line issue of The Journal of Clinical Investigation (JCI), identify a novel strategy for preventing thrombosis, and help pave the way for clinical testing of this popular flavonoid as a therapy for the prevention and treatment of stroke and heart attack, as well as deep venous thrombosis (DVT) and pulmonary embolism.
"It's not always fully appreciated that the majority of Americans will die as the result of a blood clot in either their heart or their brain," says senior author Robert Flaumenhaft, MD, PhD, an investigator in the Division of Hemostasis andThrombosis at BIDMC and Associate Professor of Medicine at Harvard Medical School. "Approximately half of all morbidity and mortality in the United States can be attributed to heart attack or stroke."
The study focused on protein disulfide isomerase (PDI) which is found in all cells. Investigators in BIDMC's Division of Hemostasis and Thrombosis had previously shown that PDI is rapidly secreted from both platelets and endothelial cells during thrombosis, when a clot forms in a blood vessel, and that inhibition of PDI could block thrombosis in a mouse model.
"This was a transformative and unanticipated finding because it identified, for the first time, that PDI is secreted from cells in a live animal and is a potential target for preventing thrombosis," says Flaumenhaft. However, because intracellular PDI is necessary for the proper synthesis of proteins, the scientists had to identify a specific compound that could block the thrombosis-causing extracellular PDI - without inhibiting the intracellular PDI.
They began by conducting a high-throughput screen of a wide array of compounds to identify PDI inhibitors. Among the more than 5,000 compounds that were screened, quercetin-3-rutinoside (rutin) emerged as the most potent agent. "Rutin was essentially the champion compound," says Flaumenhaft.
A bioflavonoid that is naturally found in many fruits, vegetables and teas including onions, apples and citrus fruits, rutin is also sold as an herbal supplement, having received a special designation for safety from the U.S. Food and Drug Administration (FDA). Surprisingly, studies of the rutin molecule demonstrated that the same part of the molecule that provides rutin with its ability to inhibit PDI also prevents the compound from entering cells. "That finding explained how this compound can be both a potent inhibitor of PDI and a safe food supplement," says Flaumenhaft. "Our next questions were, 'Is this compound anti-thrombotic? Can it prevent blood clots?'"
The team went on to test rutin in a mouse model of thrombosis. Because they knew that humans would be taking rutin in pill form, they included studies in which the compound was administered orally and determined that it successfully retained its anti-thrombotic properties when it was metabolized following oral ingestion.
"Rutin proved to be the most potently anti-thrombotic compound that we ever tested in this model," says Flaumenhaft. Of particular note, rutin was shown to inhibit both platelet accumulation and fibrin generation during thrombus formation. "Clots occur in both arteries and in veins," explains Flaumenhaft. "Clots in arteries are platelet-rich, while those in veins are fibrin-rich. This discovery suggests that a single agent can treat and prevent both types of clots."
Even with the use of existing anti-clotting therapies, such as aspirin, clopidogrel (Plavix) and warfarin (Coumadin), each year there are approximately 400,000 recurrent episodes among patients who previously experienced a stroke or heart attack, says Flaumenhaft.
"A safe and inexpensive drug that could reduce recurrent clots could help save thousands of lives," he adds. "These pre-clinical trials provide proof-of-principle that PDI is an important therapeutic target for anti-thrombotic therapy, and because the FDA has already established that rutin is safe, we are poised to expeditiously test this idea in a clinical trial, without the time and expense required to establish the safety of a new drug."
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