(Press-News.org) GREAT NECK, NY - A large, ambitious contrast of blood-thinning medications used during cardiac stent placement suggests that a very expensive drug offers no clear safety benefits over a much more affordable option, according to a prominent North Shore-LIJ researcher and cardiologist.
An insightful editorial in the Online First New England Journal of Medicine on Sept. 1 by Peter Berger, M.D., Senior Vice President for Clinical Research at the North Shore-LIJ Health System, addresses the controversial comparison of the blood thinners heparin and bivalirudin (known commercially as Angiomax). Both drugs are administered to avert life-threatening blood clots during cardiac stent placement, a very common cardiac catheterization procedure.
But bivalirudin costs more than 400 times the price of heparin, one of the oldest drugs still in widespread clinical use, and hasn't convincingly been proven to be the superior choice, Dr. Berger said.
"Many studies have shown that bivalirudin is safer than heparin - that it causes fewer bleeding complications. But other studies have shown that heparin is every bit as safe, especially when used in lower doses," said Dr. Berger, whose editorial accompanies the MATRIX Trial. "And one recent large study actually suggested that heparin is more effective than bivalirudin."
"Which trial to believe is controversial and not entirely clear," added Dr. Berger. "But nearly everyone agrees that if the more expensive blood thinner is not safer or better in some way, the less expensive one ought to be used."
Cardiac stents, mesh-like cages inserted into narrowed coronary arteries to help restore proper blood flow to the heart, are typically placed during angioplasty procedures. About 500,000 angioplasties are done in the United States each year, often to avoid heart attacks.
The MATRIX research, led by a team from the Swiss Cardiovascular Center Bern in Switzerland, will be published Online First in the Sept. 1 New England Journal of Medicine to coincide with press conferences tied to presentations at the European Society of Cardiology Congress 2015, being held in London, UK, from Aug. 29 to Sept. 2.
Like many studies, the MATRIX Trial administered other blood thinners to many participants in addition to bivalirudin or heparin, making the comparison of the two all the more complicated, Dr. Berger's editorial noted.
The MATRIX investigators also studied whether bivalirudin should be continued for four or six hours after a catheterization procedure to place a cardiac stent, or stopped when the procedure is complete. Some doctors believed that administering bivalirudin for a longer period would increase its effectiveness compared to a shorter infusion, Dr. Berger said, and also stem potentially deadly clots more effectively than heparin. But the study showed that the longer infusion offered no advantages over the shorter one.
"Many studies raise more questions than they answer," he said. "It will be interested to see whether doctors accept the results of the MATRIX Trial or wait for more studies before deciding which blood thinner they prefer."
INFORMATION:
London, UK (September 1, 2015) - Women leaving work to raise children have to redefine who they are, a study from the SAGE journal Human Relations finds. After exiting professional and managerial occupations, mothers are engaged in an ongoing mother/professional identity struggle, argue the researchers Shireen Kanji and Emma Cahusac. The process through which the mothers' choice is constructed as 'right' does not occur before their exit from work but manifests itself afterwards and intensifies over time, the study reveals.
"Analysis of mothers' sense making reveals how ...
London, UK - 1 Sept 2015: Carbonated beverages are associated with out-of-hospital cardiac arrests of cardiac origin, according to results from the All-Japan Utstein Registry presented for the first time today at ESC Congress.1 The study in nearly 800 000 patients suggests that limiting consumption of carbonated beverages may be beneficial for health.
"Some epidemiologic studies have shown a positive correlation between the consumption of soft drinks and the incidence of cardiovascular disease (CVD) and stroke, while other reports have demonstrated that the intake of ...
More than half the world's population now lives in cities. As numbers continue to swell, decision-makers across the globe grapple with how best to accommodate growing resident numbers while maintaining healthy urban ecosystems. Previous research has demonstrated that urban green spaces and trees yield far-reaching benefits to humans, from increased happiness and health to absorbing surface water run-off and storing carbon. Researchers have long debated whether it is better to build compact developments with large parks or nature reserves, as often found in Europe and Japan, ...
A new development in engineering chimeric antigen receptor (CAR) T cells, called affinity tuning, can make the CAR T cells spare normal cells and better recognize and attack cancer cells, which may help lower the toxicity associated with this type of immunotherapy when used against solid tumors, according to a preclinical study.
Many solid cancers have high levels of certain proteins such as ErbB2 and EGFR, which make them suitable targets for anticancer therapies. However, such proteins are also present at low levels in normal cells. Because of this, CAR T cells ...
Engineering chimeric antigen receptor (CAR) T cells to lower their affinity for the protein epithelial growth factor receptor (EGFR) made the cells preferentially recognize and eliminate tumor cells that have high amounts of EGFR while sparing normal cells that have lower amounts of the protein, according to a preclinical study.
CAR T cells that are currently being tested to treat B-cell malignancies target a specific protein present on leukemia and lymphoma, but these immune cells cannot distinguish cancer cells from normal cells, explained Cooper. Even though such ...
In recent years, an effort has been underway to redefine malnutrition in pediatric patients to include both the acute clinical population and the more traditional ambulatory populations. Identifying and treating malnutrition in pediatric patients is important from an acute standpoint and to ensure that children have enough nutrition to reach optimal final height and development.
Pediatric malnutrition in the clinical setting was recently defined by the Academy of Nutrition and Dietetics and A.S.P.E.N. as "an imbalance between nutrient requirements and intake that results ...
ANN ARBOR--Daily marijuana use among the nation's college students is on the rise, surpassing daily cigarette smoking for the first time in 2014.
A series of national surveys of U.S. college students, as part of the University of Michigan's Monitoring the Future study, shows that marijuana use has been growing slowly on the nation's campuses since 2006.
Daily or near-daily marijuana use was reported by 5.9 percent of college students in 2014--the highest rate since 1980, the first year that complete college data were available in the study. This rate of use is up ...
The fossil of a previously unknown species of 'sea scorpion', measuring over 1.5 meters long, has been discovered in Iowa, USA, and described in the open access journal BMC Evolutionary Biology.
Dating back 460 million years, it is the oldest known species of eurypterid (sea scorpion) - extinct monster-like predators that swam the seas in ancient times and are related to modern arachnids.
The authors named the new species Pentecopterus decorahensis after the 'penteconter' - an ancient Greek warship that the species resembles in outline and parallels in its predatory ...
Many of the most memorable stories in the history of science revolve around the conscious realization of an idea - the "Eureka!" moment. But what triggers these moments? Is there always some serendipitous event preceding a sudden epiphany, such as when Isaac Newton famously figured out gravity when he saw a falling apple?
Writing in September's Physics World, Vitor Cardoso talks about how these questions led him on a quest of discovery through the web-based project The Birth of an Idea, which he co-founded with artist Ana Souse Carvalho.
"Ana and I had been talking ...
Women living in poor areas in the UK are almost twice as likely to develop clinical anxiety as women in richer areas. However, whether men lived in poorer or richer areas made no difference to their levels of generalised anxiety disorder (GAD). These are amongst the main findings of a major survey on how socio-economic factors affect mental health in the UK.
Generalised anxiety disorder is one of the most common mental health conditions in modern society, but little objective work has taken place to show the factors in society which can lead to the development of anxiety. ...
