Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Extended use of anti-clotting drug helps some bedridden patients

07.07.2010
A treatment plan used to prevent potentially dangerous blood clots in recovering surgical patients can also benefit some patients immobilized by acute medical illness, doctors have found in a multi-institutional study.

In women, patients age 75 or older, and patients strictly confined to 24-hour bed rest, a month of extended treatment with a blood thinner significantly reduced the chances of blood clots while only slightly increasing the risk of bleeding.

Researchers at Washington University School of Medicine in St. Louis and several other institutions report the results online this week in Annals of Internal Medicine. The double-blind, placebo-controlled trial was funded by Sanofi-Aventis, the manufacturer of enoxaparin, a form of the blood thinner heparin that was used in the study.

Causes of decreased mobility of patients in the study varied and included heart failure, infections and chronic respiratory disease.

"We currently treat acutely ill medical patients with a week or two of blood thinners to prevent clots," says co-author Roger D. Yusen, MD, associate professor of medicine at Washington University. "These results suggest that, depending on the patient, physicians may want to consider extending that treatment for an additional month."

Extended treatment with a blood thinner is already standard in such contexts as recovery from knee and hip replacement surgery and abdominal cancer surgery.

Yusen is a member of the steering committee for the study, known as the EXCLAIM, or Extended Prophylaxis for Venous ThromboEmbolism (VTE) in Acutely Ill Medical Patients With Prolonged Immobilization trial.

To be eligible for the trial, patients had to be 40 years or older, have had decreased mobility within the three days prior to admission and have been likely to have decreased mobility for at least three more days after admission. Patients were given the conventional six to 14 days of enoxaparin and then randomized into two groups that received either enoxaparin or a placebo for an additional 28 days.

Researchers initially enrolled both patients who were on 24-hour bed rest and patients who were on bed rest except for the ability to use the bathroom. However, when monitoring during the early stages of the trial suggested an unfavorable risk to benefit ratio in the second group, the participation criteria for that group were adjusted to require the presence of at least one of three additional blood clot risk factors: age greater than 75 years, female gender or a previous history of a blood clot.

At the end of the treatment period, patients were scanned using an ultrasound for blood clots known as deep vein thromboses in the large veins in their upper legs.

"Clots in these areas tend to be bigger and have a greater chance of breaking away and traveling to the lungs, where they can cause a potentially fatal pulmonary embolism," Yusen says.

Researchers also followed up on patients six months after their participation in the trial began.

Their final analysis, which included results from more than 5,000 patients, showed that the rate of blood clots was 2.5 percent in the group that received extended treatment and 4 percent in the group that only received the conventional treatment, a statistically significant reduction in blood clots of 1.5 percent. Major bleeding risk was 0.8 percent in the treatment group and 0.3 percent in the placebo group, a statistically significant increase in bleeding of 0.5 percent. There was no difference in survival between the two groups.

"The benefits of extended treatment were restricted to three groups: patients who were in bed all day at the beginning of the trial, patients who were 75 years or older and female patients," Yusen says.

Yusen and his colleagues plan to further examine the results to see if they can fine-tune their recommendations for when extended-duration blood clot prevention can be beneficial.

Hull RD, Schellong SM, Tapson VF, Monreal M, Samama M-M, Nicol P, Vicaut E, Turpie AGG, Yusen RD. Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recently reduced mobility. Annals of Internal Medicine, published online.

Funding from Sanofi-Aventis supported this trial.

Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

MEDIA CONTACTS
Michael Purdy
Senior Medical Sciences Writer
(314) 286-0122
purdym@wustl.edu

Michael C. Purdy | EurekAlert!
Further information:
http://www.wustl.edu

More articles from Health and Medicine:

nachricht Usher syndrome: Gene therapy restores hearing and balance
25.09.2017 | Institut Pasteur

nachricht MRI contrast agent locates and distinguishes aggressive from slow-growing breast cancer
25.09.2017 | Case Western Reserve University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: LaserTAB: More efficient and precise contacts thanks to human-robot collaboration

At the productronica trade fair in Munich this November, the Fraunhofer Institute for Laser Technology ILT will be presenting Laser-Based Tape-Automated Bonding, LaserTAB for short. The experts from Aachen will be demonstrating how new battery cells and power electronics can be micro-welded more efficiently and precisely than ever before thanks to new optics and robot support.

Fraunhofer ILT from Aachen relies on a clever combination of robotics and a laser scanner with new optics as well as process monitoring, which it has developed...

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Fraunhofer ISE Pushes World Record for Multicrystalline Silicon Solar Cells to 22.3 Percent

25.09.2017 | Power and Electrical Engineering

Usher syndrome: Gene therapy restores hearing and balance

25.09.2017 | Health and Medicine

An international team of physicists a coherent amplification effect in laser excited dielectrics

25.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>