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 Team discovers how bacteria exploit a chink in the body's armor
20.01.2017 | University of Illinois at Urbana-Champaign

nachricht Rabies viruses reveal wiring in transparent brains
19.01.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

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: Traffic jam in empty space

New success for Konstanz physicists in studying the quantum vacuum

An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...

Im Focus: How gut bacteria can make us ill

HZI researchers decipher infection mechanisms of Yersinia and immune responses of the host

Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Sustainable Water use in Agriculture in Eastern Europe and Central Asia

19.01.2017 | Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

 
Latest News

Helmholtz International Fellow Award for Sarah Amalia Teichmann

20.01.2017 | Awards Funding

An innovative high-performance material: biofibers made from green lacewing silk

20.01.2017 | Materials Sciences

Ion treatments for cardiac arrhythmia — Non-invasive alternative to catheter-based surgery

20.01.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>