Sunday, 13 May 2012

New drugs to help prevent stroke

New more effective stroke prevention drug now available

A new anti-coagulant drug that promises to be more effective in preventing stroke in patients with atrial fibrillation, or irregular heart rhythm, is now available in private clinics here.

The Health Sciences Authority has approved the new drug - Xarelto, manufactured by Bayer, and it is expected to be out in restructured hospitals in Singapore within one to three months.

The new drug has also been approved by the Food and Drug Administration in the United States, as well as European regulators.

The approval follows a four-year clinical trial from 2006, involving more than 14,200 patients from 45 countries. Of these, 44 patients were from Singapore.

The National Heart Centre Singapore (NHCS), the National Neuroscience Institute and Khoo Teck Puat Hospital were also roped in for the global trial.

One in five strokes caused by blood clot is due to atrial fibrillation (AF).

Such patients are five times more likely to suffer from the condition than the general population. And when they do, the strokes are more severe, causing disability in more than half of the patients.

But now they have the added option of this new pill to keep the condition at bay.

A four-year clinical trial compared Xarelto with the commonly-available Warfarin, and showed that the new drug reduced the risk of stroke in patients by up to 20 per cent.

The National Coordinator of the clinical trial, Associate Professor Tan Ru San, said: "What we find with this new drug is that there is in fact reduced incidence of severe bleeds, such as bleeds that can cause death and bleeding in the brain as well."

Patients on the alternative drug Warfarin also have to adhere to dietary restrictions and drug-drug interactions.

"Patients on Warfarin actually have a very limited quality of life because they have to come back regularly for INR (blood test) monitoring to ensure that the drug is being taken at the correct dose to ensure efficacy," added Associate Professor Tan.

Atrial fibrillation causes about 15 per cent of hospital admissions due to stroke.

With Singapore's rapidly ageing population, the burden of atrial fibrillation-related stroke is expected to go up.

Globally, the number of people suffering from this condition is also expected to rise by more than two-fold by 2050.

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Blood thinner works as well as aspirin in heart patients

Aspirin works as well as the blood thinner warfarin, or Coumadin, in most patients with heart failure when it comes to preventing death, stroke or brain hemorrhage, said a major international study on Wednesday.

The findings published in the New England Journal of Medicine came from a landmark clinical trial that lasted 10 years and tracked 2,305 patients in 11 countries.

The combined risk of death, stroke, and cerebral hemorrhage was 7.47 percent per year for patients taking warfarin, and 7.93 percent per year for those taking aspirin, a difference that researchers said was not statistically significant.

Patients taking the blood thinner had half the stroke risk of people taking aspirin, but warfarin patients had double the risk for major bleeding, and so those two factors cancelled each other out, researchers said.

There was some evidence among warfarin patients followed for four years or more that the blood thinner may have superior benefits in warding off death, stroke or brain hemorrhage but more analysis is needed, the study said.

"Since the overall risks and benefits are similar for aspirin and warfarin, the patient and his or her doctor are free to choose the treatment that best meets their particular medical needs," said lead investigator Shunichi Homma of Columbia University Medical Center.

"However, given the convenience and low cost of aspirin, many may go this route."

Heart failure can hike the risk of blood clots that may cause stroke. Aspirin prevents the blood from clotting and warfarin, available by prescription, thins the blood.

"With at least six million Americans -- and many more around the world -- suffering from heart failure, the results of the WARCEF study will have a large public health impact," said Walter Koroshetz, deputy director of the National Institute for Neurological Disorders and Stroke.

"The key decision will be whether to accept the increased risk of stroke with aspirin, or the increased risk of primarily gastrointestinal hemorrhage with warfarin," he said.

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New drug to help prevent stroke in heart patients

SINGAPORE - A new anti-coagulant drug that promises to be more effective in preventing stroke in patients with atrial fibrillation - a heart rhythm disorder - is now available in private clinics.

Called Xarelto, it is manufactured by Bayer and is expected to be out in restructured hospitals here in one to three months.

A clinical trial was conducted over four years from 2006 to determine the efficacy of the new drug. It was tested on more than 14,200 patients from 45 countries. Of these, 44 patients were from Singapore. Also involved in the trial were the National Heart Centre Singapore (NHCS), the National Neuroscience Institute and Khoo Teck Puat Hospital.

The clinical trial, using the double-blind and double-dummy method to prevent biases, is described by NHCS cardiologist Professor Tan Ru San as "one of the most robust".

Double-blindness means researchers and patients had no clue which treatment was given, while double-dummy refers to standardised patient monitoring.

The trial showed that the new drug reduced the risk of stroke in patients by up to 20 per cent, compared to the commonly-prescribed drug, Warfarin. Other findings include fewer cases of haemorrhagic stroke and mortality.

Atrial fibrillation causes about 15 per cent of hospital admissions due to stroke, and the burden of the condition is expected to rise with Singapore's rapidly-ageing population.

Atrial fibrillation stroke is expected to rise as the number of people worldwide with the condition is estimated to increase by more than two-fold by 2050.

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