By Robert Preidt
HealthDay Reporter
THURSDAY, Dec. 1, 2016 (HealthDay Information) -- Use of a blood thinner is routine for a lot of coronary heart sufferers, however these medicine include a danger of episodes of extra bleeding.
What, if any, anticoagulant (blood thinner) ought to these sufferers take after such episodes come up?
A brand new examine means that the blood thinner Pradaxa (dabigatran) could also be a better option than the standby drug warfarin in these circumstances.
The explanation: Pradaxa is much less probably than warfarin to trigger recurrent bleeding in sufferers who lately suffered a bleeding stroke or different main bleeding occasion, the researchers discovered.
"Our outcomes ought to encourage clinicians to noticeably contemplate resuming anticoagulation amongst sufferers who survived a serious bleeding occasion, significantly if the supply of bleeding was recognized and addressed," mentioned examine senior creator Dr. Samir Saba. He is affiliate chief of cardiology on the College of Pittsburgh Coronary heart and Vascular Institute.
As Saba's crew defined, each warfarin and Pradaxa are anticoagulants, typically prescribed to forestall blood clots in individuals in danger for stroke or coronary heart assault.
Nonetheless, blood thinners additionally enhance the chance of extreme bleeding, resembling within the mind or intestine, as a result of they lower the blood's capability to clot.
Which means that "if a affected person who's on an anticoagulant to keep away from a stroke has a serious bleeding occasion, medical doctors are confronted with a catch-22: discontinue the anticoagulant to keep away from future bleeding, however once more place their affected person at elevated danger of stroke; or resume the anticoagulant to proceed avoiding a stroke, however then have to fret about one other bleeding occasion," examine lead creator Inmaculada Hernandez mentioned in a college information launch. She's assistant professor of pharmacy on the college.
To study extra about how greatest to deal with sufferers on anticoagulants that suffer a serious bleeding occasion, the researchers in contrast 2010-2012 information from almost 90,000 sufferers who stuffed prescriptions for Pradaxa or warfarin.
Greater than 1,500 of the sufferers suffered a serious bleeding occasion whereas taking the medicine, and about half of them resumed taking one of many two blood thinners just a few months after the bleeding occasion.
Continued
Stopping blood thinner use altogether was clearly the less-safe possibility, the examine discovered. For instance, the chance of loss of life from any trigger, or of getting a stroke, was 23 to 34 % increased in sufferers who stopped taking anticoagulants altogether, in comparison with those that resumed taking the medicine.
And Pradaxa appeared to beat out warfarin by way of security, the Pittsburgh group discovered. Individuals who took Pradaxa after their bleeding occasion had been almost half as more likely to have one other main bleeding occasion inside one yr in comparison with those that took warfarin.
Two specialists who reviewed the findings mentioned that selections like these are all the time troublesome.
"Each sufferers and physicians are reluctant to renew blood thinners as soon as there was a bleeding complication," mentioned Dr. Kevin Marzo, chief of cardiology at Winthrop-College Hospital in Mineola, N.Y.
He mentioned the brand new examine helps the notion, nevertheless, that resuming a blood thinner after a bleeding episode continues to be the most secure path for many sufferers. "This discovering may ease a few of the nervousness in reinitiating blood thinners," Marzo mentioned.
Dr. Richard Libman is vice chair of neurology at Lengthy Island Jewish Medical Heart in New Hyde Park, N.Y. He mentioned the brand new analysis echoes outcomes of prior research that had instructed Pradaxa had a slight benefit over warfarin in these eventualities.
However he additionally confused that the brand new examine was "observational" -- not the "gold normal" potential, randomized trial, so agency conclusions cannot be made.
"Nonetheless, the take-home message is that when you have had severe bleeding whereas on blood-thinning medicine, more often than not you'll profit from finally restarting blood thinning medicine," Libman mentioned.
The examine was printed Dec. 1 within the journal Stroke.
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