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Welcome Alternative To Warfarin For People At High Risk Of Stroke (pp 1686, 1691)
November 19, 2003Results of an international study in this week's issue of THE LANCET provide strong evidence that the oral direct thrombin-inhibitor ximelagatran could be a safe and effective alternative to warfarin in reducing stroke among people with atrial fibrillation.
Atrial fibrillation (irregular and rapidly beating atria) increases the risk of cardiac blood clots, which can cause ischaemic stroke. Warfarin has been used for decades for people at high risk of stroke because of its blood-thinning capability; however there are many drawbacks of warfarin treatment: an increased risk of bleeding, and possible interaction with food and other medication necessitating at least monthly blood testing and frequent dose adjustment. The oral direct thrombin-inhibitor ximelagatran could be a more reliable alternative to warfarin for people at high stroke risk.
In an international study (SPORTIF III: Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation), 3407 patients from Europe, Asia, and Australia with atrial fibrillation and one or more stroke risk factors were randomly allocated warfarin or oral ximelagatran. Average follow-up took place after 17 months.
Oral ximelagatran was at least as effective in reducing the frequency of stroke or systemic blood clots (the primary outcomes) as warfarin (relative risk reduction 30%, absolute risk reduction 0.7% for ximelagatran; however this was not statistically significant). Rates of disabling or fatal stroke, death, and major bleeding were similar between both groups.
Lead investigator S Bertil Olsson from University Hospital Lund, Sweden, comments: "We have shown that ximelagatran, administered in a fixed dose without coagulation monitoring, protects high-risk patients with atrial fibrillation against thromboembolism at least as effectively as well-controlled warfarin, and is associated with less bleeding. The preliminary reported SPORTIF V trial presented at the November 2003 American Heart Association meeting has further verified the efficacy and safety in a similar population."
In an accompanying Commentary (p 1686), Freek Verheugt from University Medical Centre, Nijmegen, Netherlands, concludes: "If safety seems good in a broader population of patients, ximelagatran may find its way into general use in atrial fibrillation. But this process will take a while, and in the meantime the ACTIVE study with clopidogrel, which has a more established safety profile than ximelagatran so far, will be finished. Depending on the outcome, physicians willing to switch from warfarin for patients with atrial fibrillation must decide which agent they will go for."
Lancet
Oral ximelagatran was at least as effective in reducing the frequency of stroke or systemic blood clots (the primary outcomes) as warfarin (relative risk reduction 30%, absolute risk reduction 0.7% for ximelagatran; however this was not statistically significant). Rates of disabling or fatal stroke, death, and major bleeding were similar between both groups.
Lead investigator S Bertil Olsson from University Hospital Lund, Sweden, comments: "We have shown that ximelagatran, administered in a fixed dose without coagulation monitoring, protects high-risk patients with atrial fibrillation against thromboembolism at least as effectively as well-controlled warfarin, and is associated with less bleeding. The preliminary reported SPORTIF V trial presented at the November 2003 American Heart Association meeting has further verified the efficacy and safety in a similar population."
In an accompanying Commentary (p 1686), Freek Verheugt from University Medical Centre, Nijmegen, Netherlands, concludes: "If safety seems good in a broader population of patients, ximelagatran may find its way into general use in atrial fibrillation. But this process will take a while, and in the meantime the ACTIVE study with clopidogrel, which has a more established safety profile than ximelagatran so far, will be finished. Depending on the outcome, physicians willing to switch from warfarin for patients with atrial fibrillation must decide which agent they will go for."
Lancet
Stroke Current Events and Stroke News RSSNew understanding about mechanism for cell death after stroke leads to possible therapy
Scientists at the Brain Research Centre, a partnership of the University of British Columbia Faculty of Medicine and Vancouver Coastal Health Research Institute, have uncovered new information about the mechanism by which brain cells die following a stroke, as well as a possible way to mitigate that damage.
Surgery not linked to memory problems in older patients
For years, it has been widely assumed that older adults may experience memory loss and other cognitive problems following surgery. But a new study from researchers at Washington University School of Medicine in St. Louis questions those assumptions.
Pushing the brain to find new pathways
Until recently, scientists believed that, following a stroke, a patient had about six months to regain any lost function. After that, patients would be forced to compensate for the lost function by focusing on their remaining abilities.
Night Beat, Overtime and a Disrupted Sleep Pattern Can Harm Officers' Health
A police officer who works the night shift, typically from 8 p.m. to 4 a.m., already is at a disadvantage when it comes to getting a good "night's" sleep.
Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.
The benefits of exercise
Physical exercise is one of the most effective methods of preventing disease. The current issue of Deutsches Arzteblatt International is devoted to this important topic.
Heart and bone damage from low vitamin D tied to declines in sex hormones
Researchers at Johns Hopkins are reporting what is believed to be the first conclusive evidence in men that the long-term ill effects of vitamin D deficiency are amplified by lower levels of the key sex hormone estrogen, but not testosterone.
New study links vitamin D deficiency to cardiovascular disease and death
While mothers have known that feeding their kids milk builds strong bones, a new study by researchers at the Heart Institute at Intermountain Medical Center in Salt Lake City suggests that Vitamin D contributes to a strong and healthy heart as well - and that inadequate levels of the vitamin may significantly increase a person's risk of stroke, heart disease, and death, even among people who've never had heart disease.
Early end to key study on benefits of niacin, a B vitamin, in keeping arteries open was premature
Heart experts at Johns Hopkins are calling premature the early halt of a study by researchers at Walter Reed Army Medical Center and Washington Hospital Center on the benefits of combining extended-release niacin, a B vitamin, with cholesterol-lowering statin medications to prevent blood vessel narrowing.
Study finds many people with hemianopia have difficulty detecting pedestrians while driving, advocates for individual testing
Schepens Eye Research Institute scientists have found that--when tested in a driving simulator--patients with hemianopia (blindness in one half of the visual field in both eyes) have significantly more difficulty detecting pedestrians (on their blind side) than normally sighted people.
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