New drug targets clots: A potential treatment for heart attack and stroke prevention

For discussion with your doctor.  But they don't even tell you the name of the drug, or is it to be named yet?

New drug targets clots: A potential treatment for heart attack and stroke prevention

MedicalXpress Breaking News-and-Events|July 22, 2020

Monash researchers have developed a drug that can be potentially given as a preventative against heart attack. The drug—which has been studied in human cells and animal models—literally blocks the minute changes in blood flow that preempts a heart attack and acts on the platelets preventing the platelet-triggered clot before it can kill or cause damage.

Importantly, the drug may have a role in preventing the clotting that is the hallmark of COVID-19.

One third of all deaths globally—18 million a year—are caused by cardiovascular disease, largely heart attack or stroke, both of which are triggered by clots blocking the vessels in the brain or heart.

While drugs like aspirin, given at the time of the attack, can prevent further clots forming, they only work in 25 per cent of cases, and these drugs can cause serious side effects from bleeding. According to the lead scientist on the paper, published in the prestigious journal, Science Translational Medicine, Associate Professor Justin Hamilton, from the Monash University Australian Centre of Blood Diseases, "there has been no new drugs to treat, let alone prevent, heart attack or stroke in more than 15 years," he said.

Associate Professor Hamilton said the researchers stumbled across the potential drug by accident. They were looking at changes within platelets that occur around the time of what is called a pathological setting, ie a heart attack or stroke. They found an enzyme of interest, isolated the gene responsible and developed a mouse that was missing just that gene.

The mice—to their surprise—were completely protected against heart attack. But why this enzyme provided protection remained a mystery for two years. "It drove us mad," Associate Professor Hamilton said.

The researchers used electron microscopy to cut ultrathin "slices" of the platelets from these mice to see what was going on. What they saw was a slightly modified membrane, which appears to prevent these platelets from attaching to each other or to blood vessel walls, the minute that there is a change in blood flow. "It is this blood flow perturbation which is a hallmark and predictor of a heart attack," Associate Professor Hamilton said.

"This enzyme allows the platelets to respond to this blood flow change and to "gear up" their capacity to clot, causing an attack."

Once the researchers were aware of the importance of the enzyme, they developed a drug that could shut this process down, in animal models and in laboratory models using human blood. This drug has the potential to be given to patients at risk of heart attack and stroke, to prevent blood clots forming when there is a risk of attack.

The next step is to develop a more suitable drug candidate that could be taken into a clinical trial, according to Associate Professor Hamilton. Initially he is hoping to test the drug on patients who have a higher risk of cardiovascular disease, such as those with diabetes.

These same clots—targeted by the Monash drug—have recently been linked to COVID-19 as a key cause of death from the disease. Associate Professor Hamilton said that, while it is early days, "the possibility of using our newly developed anti-thrombotic to improve the treatment of COVID-19 patients is an appealing idea we would like to explore."

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Katie May Dies: What Caused Her Stroke?

Lots of speculation here and no clarification at all from our knowledgeable stroke associations. These high profile deaths should be analyzed properly so we have correct information out there about strokes.

Katie May Dies: What Caused Her Stroke?

"It is with heavy hearts that we confirm the passing today of Katie May – mother, daughter, sister, friend, businesswoman, model and social media star – after suffering a catastrophic stroke caused by a blocked carotid artery on Monday," the statement reads.
Wrong, a blocked carotid artery does not directly cause a stroke, if a complete Circle of Willis exists such blockage is no problem at all.
"Pinched a nerve in my neck on a photoshoot and got adjusted this morning. It really hurts!"
If adjusted means a chiropractic adjustment, that is likely the smoking gun.
Tragically, sources believe the 34-year-old model did NOT actually pinch a nerve, but instead tore the carotid artery in her neck.
Physicians told her family members that this tear caused a blood clot ... which broke off and caused her stroke on Monday.
This throwing of the clot is the reason for the stroke.

Stroke Rounds: Novel Clot Buster Flops Again - desmoteplase

I guess vampire bat saliva doesn't work that well. I would argue that the Rankin scale used to evaluate effectiveness is totally inappropriate. If you want to do this objectively you run daily MRI scans to see if the size of the dead area increases less with interventions vs. placebo. Still to be tested;
1. liposome-encapsulated hemoglobin written in Feb. 2010
2. bat saliva - Draculin  written in May, 2011, up to 9 hours OK, maybe a no go
3. cardiac glycosides written in Feb. 2006 - up to 6 hours
4.inhalation of nitric oxide written in March, 2012 - 48 hours to 7 days
5. Nitric oxide written in 2006, to be tested in humans yet.
6. xenon gas written in Feb. 2006, to be tested yet
7. caffeinol irish coffee injection written in April 2003 to be tested in humans
8. Docosahexaenoic acid (DHA), a component of fish oil written in Nov. 2010, up to 5 hours
9. nicotine written in July 2005, to be tested in humans
10. Viagra written in 2002, to be tested in humans,  for 7 days
11.
11. Enzogenol  written in Nov. 2011 for New Zealand
12 edaravone approved in Japan since 2001
13. nitroglycerin instructions
14. benzodiazepine inverse agonist  written in Nov. 2010 

http://www.medpagetoday.com/Cardiology/Strokes/51760?xid=nl_mpt_DHE_2015-05-27&eun=g424561d0r

New Breakthrough in Hemorrhagic Stroke Treatment

The writeup doesn't make sense, clots vs. hemorrhagic in the title.
http://www.strokesmart.org/new-hemorrhagic-stroke-treatment
The following refers to a clot removal.
Read about a stroke patient who benefitted from this procedure. Dr. Shah says that this surgery should be performed within 8 hours of the stroke occurring.

Pradaxa antidote works fast, completely in small trial

And maybe we don't need rat poison anymore. The lack of an antidote was the reason a friend of mine discontinued use.
http://whtc.com/news/articles/2013/nov/18/pradaxa-antidote-works-fast-completely-in-small-trial/
An experimental antidote to the widely used blood clot preventer Pradaxa worked immediately and completely in an early-stage trial among healthy volunteers, raising hopes that the drug's blood-thinning effects can be reversed in emergency situations.
"These are absolutely exciting findings," said Dr. Stephan Glund, a research executive of privately held Boehringer Ingelheim Pharmaceuticals, the German drugmaker that developed Pradaxa and is testing the antidote.
Pradaxa, also known as dabigatran, was approved in 2010 to prevent strokes in patients with atrial fibrillation, an irregular heartbeat that affects more than 2.5 million American adults and which raises the risk of stroke fivefold. It works by blocking thrombin, a blood enzyme involved with clotting.

'Clot nets' help stroke recovery

I'm glad they are coming up with alternative ways of clearing clots but I wish they would also focus on the secondary deaths due to the neuronal cascade of death. Pericytes, excitotoxicity, glutamate poisioning.
http://www.thedailystar.net/newDesign/news-details.php?nid=247258
Using small nets to extract blood clots from patients' brains may be the future of stroke care, according to two studies.
Clots block blood vessels, starving parts of the brain of oxygen, which leads to symptoms such as paralysis and loss of speech.
Two studies, presented in the Lancet medical journal, suggest extracting clots with nets could improve recovery.
The Stroke Association said it was very excited by the treatment's potential.
There are already techniques for reopening blocked blood vessels in people's brains.
Some patients will be given "clot-busting" drugs, but this needs to be in the hours just after the stroke and is not suitable for everyone.
CLOT EXTRACTION
Other techniques have been developed to extract the clot. Some procedures pass a tube up through the groin to the brain. There the wire passes through the clot, forming a coil on the far side and then pulling the clot out. However, this is far from routine practice.
The latest methods involve a tiny wire cage instead of a coil. This pushes the clot up against the walls of the artery and enmeshes the clot in the wires, allowing doctors to pull the clot back out of the groin.
Two similar devices were compared with the current coil methods. One trial of 113 patients showed 58 percent had good brain function after three months, compared with 33pc of those treated with the coil method, as well as a lower death rate.
Another study in 178 patients showed almost double the chance of living independently after treatment.
One of the researchers involved, Prof Jeffrey Saver from the University of California, Los Angeles, told the BBC that these techniques would become more common, as they are more likely to clear clots than drugs.
"Clot-busting drugs only partially reopen 40pc of large blocked arteries. These devices partially reopen 70-90pc of large blocked arteries.
"Second, these devices can be used in patients in whom it is not safe to give 'clot busting' drugs, such as patients taking anticoagulant medications, patients who had recent surgery, and patients who are between 4.5 to eight hours after stroke onset."
In the long term he can see drugs being used as a first option and then clot removal if the drugs fail or cannot be used.
'MAJOR STEPS FORWARD’
Responding to the research, the Stroke Association's Dr Clare Walton said clot-busters did not work for all patients so new techniques could help many patients.
She added: "Clot retrieval devices have the potential to be used with more stroke patients and are better at removing blood clots than clot-busting drugs.

Killer combinations

Some things your doctor should have warned you about.
http://www.fox23news.com/content/healthalert/story/Killer-combinations/0VS8-gb26kmiU49X6kVtRg.cspx
Pill after pill after pill.

From prescription to over-the counter, medicinal mistakes put at least 1.3 million Americans at risk of premature death each year. The wrong combination of foods and drugs, at the wrong time could make a life or death difference. For Debra Jacobson, it was blood pressure meds. At her worst, she hit a dangerous 210 over 190! Normal is 120 over 80.

"He took my pressure and he sent me to another doctor he said 'you're gonna die' I said… 'not ready," Debra said.

Her doctor's advice? It all came down to her medicine.

"He said you need to take it at night," Debra said.

Within three days she saw a drastic change. Doctor Alan Ackermann says taking blood pressure meds at night can cut your risk of heart attack and stroke by one-third!

"It's called a silent killer for a reason," Dr. Alan Ackermann.

Another mistake? Mixing cholesterol lowering meds like statins with grapefruit. (I was only warned about this when on warfarin)

The grapefruit breaks down some statins too quickly, making them too toxic to fast. To be safe, talk to your doctor about what you're taking and time your meds for eight to 12 hours after you eat grapefruit. Another deadly combo?

Alcohol and acetaminophens. While most won't shoot whiskey with their Tylenol, popping just one to stave off a morning hangover-could put you at risk for liver failure! not a drinker? Not off the hook! Most women know smoking while on birth control can cause blood clots, but just one cigarette could cause a blocked artery in your lung. Finally, the same pills you take for pain could be raising your blood pressure! as much as 20 points higher!

"Most people aren't aware ibuprofen, Motrin, Advil do contain salt," Dr. Ackerman said.

Whether it's watching what you do or when you do it, like Debra it could save your life.

Brain vacuum technique reverses the effects of stroke

tPA somewhat worked for me but the massiveness of my stroke was not due to the original clot, it was the neuronal cascade of death.
http://www.gizmag.com/stroke-prevention-brain-vacuum/15368/

Twenty-seven stroke victims are alive and well today because of a new tool that vacuums clots out of blood vessels in the brain. Known as the Penumbra System of Continuous Aspiration Thrombectomy, the technology has been assessed at the Seaman MR Research Centre at Canada’s University of Calgary. If used within a few hours of a stroke, it can restore blood flow to the brain, thus reversing the effects of the stroke and preventing any permanent brain damage.
Medical technology firm Penumbra designed the tool. The process involves going in through the patient’s groin, and threading a tiny catheter into a blood vessel. That catheter goes up to the neck, at which point an even smaller catheter emerges from it and goes into the brain, whereupon it vacuums out the blood clot. "It requires years of training to be able to do this," said Dr. Mayank Goyal, director of the Seaman Centre. "It places enormous demands on the interventionalist, on the imaging specialists, and on the emergency team that gets the patient to a designated stroke care facility. Teamwork is key for success.”
Dr. Goyal added that the procedure will only work on massive strokes, so it is vital that patients are assessed via a CT scan as soon as possible. As revolutionary as the tool itself may be, it is of the utmost importance that medical staff are able to quickly determine which patients are candidates. To that end, Goyal is now working on a website that will help other physicians interpret CT scans accordingly.