New Blood Thinner Beats Plavix When Paired With Low-Dose Aspirin (HealthDay)

MONDAY, June 27 (HealthDay News) -- Brilinta, an experimental anti-clotting medication currently awaiting U.S. Food and Drug Administration approval, performed better than the industry standard, Plavix, when used in tandem with low-dose aspirin, a new study finds.

Heart patients who took Brilinta (ticagrelor) with low-dose aspirin (less than 300 milligrams) had fewer cardiovascular complications than those taking Plavix (clopidogrel) plus low-dose aspirin, researchers found.

However, patients who took Brilinta with higher doses of aspirin (more than 300 milligrams) had worse outcomes than those who took Plavix plus high-dose aspirin, the investigators reported.

Antiplatelet drugs are used to prevent potentially dangerous blood clots from forming in patients with acute coronary syndrome, including those who have had a heart attack.

Brilinta has already been approved for use in many other countries. In July 2010, an FDA panel voted 7-to-1 to approve the use of Brilinta for U.S. patients undergoing angioplasty or stenting to open blocked arteries, but the approval process is still ongoing.

The panel's recommendation was based in part on prior findings from this study, called the Platelet Inhibition and Patient Outcomes (PLATO) trial.

In this latest analysis of PLATO findings, researchers found that patients who took Brilinta with low-dose aspirin were 16 percent less likely than those who took Plavix with low-dose aspirin to have a heart attack or stroke, or to die within a year.

The findings were reported Monday in an American Heart Association online conference.

One expert said the new information is valuable.

"The study highlights that if one chooses to use ticagrelor in subjects with acute coronary syndromes, it would be logical to use aspirin 81 milligrams per day (and not 325 mg daily)," said Dr. Jeffrey S. Berger, assistant professor of medicine and director of cardiovascular thrombosis at NYU Langone Medical Center in New York City. "Of note, there is little reason to ever use aspirin 325 mg except in the acute setting of a heart attack or stroke," he added. "A higher aspirin dose (325 mg versus 81 mg) increases the risk of bleeding without increasing the efficacy of the drug."

A study author agreed that for most patients, using the drug with a lower dose of aspirin is usually warranted.

"Patients with acute coronary syndrome have options to prevent recurrent events," study lead author Dr. Kenneth W. Mahaffey, co-director of cardiovascular research at the Duke Clinical Research Institute, and associate professor of medicine at Duke University Medical Center, said in an AHA news release. "Physicians choosing to use ticagrelor in countries where it is approved and available should consider using a low-dose of maintenance aspirin with the drug."

The data and conclusions of the research should be viewed as preliminary until published in a peer-reviewed journal.

More information

The American Academy of Family Physicians outlines medicines used to treat patients with acute coronary syndrome.

New Blood Thinner Beats Plavix When Paired With Low-Dose Aspirin (HealthDay)

MONDAY, June 27 (HealthDay News) -- Brilinta, an experimental anti-clotting medication currently awaiting U.S. Food and Drug Administration approval, performed better than the industry standard, Plavix, when used in tandem with low-dose aspirin, a new study finds.

Heart patients who took Brilinta (ticagrelor) with low-dose aspirin (less than 300 milligrams) had fewer cardiovascular complications than those taking Plavix (clopidogrel) plus low-dose aspirin, researchers found.

However, patients who took Brilinta with higher doses of aspirin (more than 300 milligrams) had worse outcomes than those who took Plavix plus high-dose aspirin, the investigators reported.

Antiplatelet drugs are used to prevent potentially dangerous blood clots from forming in patients with acute coronary syndrome, including those who have had a heart attack.

Brilinta has already been approved for use in many other countries. In July 2010, an FDA panel voted 7-to-1 to approve the use of Brilinta for U.S. patients undergoing angioplasty or stenting to open blocked arteries, but the approval process is still ongoing.

The panel's recommendation was based in part on prior findings from this study, called the Platelet Inhibition and Patient Outcomes (PLATO) trial.

In this latest analysis of PLATO findings, researchers found that patients who took Brilinta with low-dose aspirin were 16 percent less likely than those who took Plavix with low-dose aspirin to have a heart attack or stroke, or to die within a year.

The findings were reported Monday in an American Heart Association online conference.

One expert said the new information is valuable.

"The study highlights that if one chooses to use ticagrelor in subjects with acute coronary syndromes, it would be logical to use aspirin 81 milligrams per day (and not 325 mg daily)," said Dr. Jeffrey S. Berger, assistant professor of medicine and director of cardiovascular thrombosis at NYU Langone Medical Center in New York City. "Of note, there is little reason to ever use aspirin 325 mg except in the acute setting of a heart attack or stroke," he added. "A higher aspirin dose (325 mg versus 81 mg) increases the risk of bleeding without increasing the efficacy of the drug."

A study author agreed that for most patients, using the drug with a lower dose of aspirin is usually warranted.

"Patients with acute coronary syndrome have options to prevent recurrent events," study lead author Dr. Kenneth W. Mahaffey, co-director of cardiovascular research at the Duke Clinical Research Institute, and associate professor of medicine at Duke University Medical Center, said in an AHA news release. "Physicians choosing to use ticagrelor in countries where it is approved and available should consider using a low-dose of maintenance aspirin with the drug."

The data and conclusions of the research should be viewed as preliminary until published in a peer-reviewed journal.

More information

The American Academy of Family Physicians outlines medicines used to treat patients with acute coronary syndrome.

Single Reading Can't Gauge Blood Pressure Control: Study (HealthDay)

By Kathleen Doheny
HealthDay Reporter by Kathleen Doheny
healthday Reporter – Mon?Jun?20, 11:48?pm?ET

MONDAY, June 20 (HealthDay News) -- Evaluating how well a person responds to medication meant to lower blood pressure requires multiple readings, new research suggests.

Blood pressure often spikes at doctor appointments, a condition known as "white coat" hypertension, so readings should also be taken by patients at home, said the study's lead author, Dr. Benjamin Powers, assistant professor of medicine at Duke University Medical Center.

''Collecting just a few, five or six, blood pressure readings from home will help your doctor make much better decisions about whether your blood pressure is in or out of control," Powers said.

For the study, Powers and his colleagues evaluated 444 U.S. veterans with high blood pressure, about 90 percent of them men with an average age of 64. All had been diagnosed about 10 years earlier. Their blood pressure was considered uncontrolled, even though most took multiple blood pressure-lowering medications. Untreated, high blood pressure can lead to stroke.

The study compared blood pressure readings taken in three settings -- at home, in a doctor's office, and at a clinical research setting -- at the study start and again at 6, 12 and 18 months. The findings are published in the June 21 issue of the Annals of Internal Medicine.

The measurements varied widely, Powers found. "Only a third of them were consistently categorized as in or out of control by all three measures," he said.

That points to the importance of getting multiple measures from different settings, said Powers, who is also with the Durham Veterans Affairs Medical Center. Using just one reading as the basis for prescribing or adjusting blood pressure medication could endanger patients who suffer from "white coat" hypertension, the study authors said.

As many as six readings were needed to obtain the best estimate of true blood pressure, the authors said, adding that doctors should average the results.

Home monitoring of blood pressure has gained respect in recent years, Powers said. About 43 percent of people with high blood pressure use home monitors, according to background information in the study. Powers and his colleagues said their results support recent calls for reimbursement of home blood pressure monitoring.

"I think patients should expect their doctors to make decisions based on home blood pressure [in addition to other measures]," he said.

Those who buy a home blood pressure monitor should get it validated for accuracy at their doctor's office, Powers added.

Patients should be advised to measure their blood pressure at different times of the day, and to sit and relax for five minutes before taking it, Powers explained. Variations are to be expected, he noted.

According to Dr. Joseph Diamond, director of nuclear cardiology at Long Island Jewish Medical Center in Hyde Park, N.Y., blood pressure readings are perhaps "the most frequent assessment that results in a change of medical therapy."

Even so, the procedure is frequently flawed because of poor measurement technique or insufficient measurements, he said.

"This study confirms the need to improve both measurement technique and the number of measurements obtained so that a therapeutic decision to start or change medication is based on more accurate information," said Diamond.

Writing in an accompanying editorial of the journal, Dr. Lawrence J. Appel and colleagues from Johns Hopkins University said the findings point to a need for regulation of blood pressure screening. "It is time to get serious about BP measurement," they wrote.

More information

To learn more about home blood pressure monitoring, visit the British Hypertension Society.