There's a new anticoagulant that's in trials on people with AF. It appears to cause minimal bleeding. This is an extract from a Times article:
Blood clot treatment may help reduce hospital deaths
Tom Whipple, Science Editor
Tuesday July 20 2021, 12.01am, The Times
Blood clots are responsible for one in four deaths worldwide and cause heart attacks and strokes
Blood clots are responsible for one in four deaths worldwide and cause heart attacks and strokes
A new treatment for preventing blood clots that has been shown to be effective in trials could help to tackle a major cause of hospital deaths.
A study involving 400 patients showed that a drug based on artificial antibodies significantly outperforms existing care in preventing clots. It also appears to be unlikely to produce bleeding as a side effect.
People can be at risk from thromboses after many kinds of surgery.
Thrombosis UK calls such clots the leading preventable cause of deaths in hospital. They are also a concern in people with a range of other conditions, including common heart problems.
“One in four deaths worldwide is due to clotting,” Jeffrey Weitz, of McMaster University, Canada, said. “It’s the underlying cause of most heart attacks and strokes . . . so this is a huge problem, and one for which we need better treatments.”
After surgery, patients are often given anticoagulants, designed to prevent clotting. To test anticlotting drugs, doctors have in the past typically looked at knee surgery, because it is well-understood, semi-routine, but produces a lot of clots.
Among those knee surgery patients receiving the traditional treatment the research, published in the New England Journal of Medicine, found that 22 per cent went on to suffer a clot.
The new drug, called abelacimab, is based on artificial antibodies designed to attack the enzymes used in one stage of the clotting process. Among those given a low-dose injection of it, 13 per cent went on to get clots. In higher doses, that figure was 4 per cent.
The findings, which come from a Phase 2 trial, suggest that abelacimab could be a significantly more effective treatment — and be applied to other conditions. It is already being tested in people with atrial fibrillation, or an irregular heartbeat.
“One in four people over 80 have atrial fibrillation, and it increases your risk of stroke fivefold,” Weitz said. “It makes clots worse when they appear.”
A problem with tackling clots in atrial fibrillation is that interfering with the natural clotting process increases the risk of internal bleeding.
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MarkS
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Thanks for sharing that interesting article MarkS. That’s the second innovation for me today relating to the heart as I just watched a new upload to YouTube from Dr Sanjay Gupta regarding trials of a new leadless pacemaker. Isn’t science wonderful?
"have atrial fibrillation, and it increases your risk of stroke fivefold," Interesting how this mantra is dutifully repeated practically every time Afib is mentioned. Does this mean quite a few people are ignoring it? Anyway, I have yet to see a study confirming this number.
OK, thanks. Obviously "fivefold" applies to the highest CHADS score. According to this doctor mdcalc.com/chads2-score-atr... 0 score, lone AF, the annual risk of a stroke is 3,2%, for the highest highest score, 6, the risk is 18,2%.
This is very interesting. I have listened to, and been intimidated by the 'fivefold' mantra since first realising I had AF some years ago, yet it seems from your last post that this figure actually only applies to the worst case patients who top score on the Chads2Vasc protocol. The figure used for someone like me, with lone AF and a 0 score, is expressed as about 3.2%.
To turn this around, my chances of NOT having a stroke are 96.8%.
Is this correct, or an I kidding myself?
Anyone else got an opinion or some knowledge on this?
That is what I was thinking. The comments, affirmative or not, are more than welcome. We are all interested. For example, before cardioversion, you may have a procedure called a transesophageal echocardiogram to check for blood clots in your heart. The same for the ablations. Now, is there any research into how many blood clots were actually found and in what type (CHADS score) of patients?
I'm afraid you're kidding yourself. The five fold figure came from the highly respected Framlingham study: "The impact of nonrheumatic atrial fibrillation, hypertension, coronary heart disease, and cardiac failure on stroke incidence was examined in 5,070 participants in the Framingham Study after 34 years of follow-up. Compared with subjects free of these conditions, the age-adjusted incidence of stroke was more than doubled in the presence of coronary heart disease (/?< 0.001) and more than trebled in the presence of hypertension (p<0.001). There was a more than fourfold excess of stroke in subjects with cardiac failure (/><0.001) and a near fivefold excess when atrial fibrillation was present (/»<0.001)."
That is where the condition exists on its own. Where other factors apply as well as AF, the risk is increased even more.
The full report from the study is here: ahajournals.org/doi/pdf/10....
Thanks Mark; back to square one then. Even if it's not the statistic I would have preferred, knowledge is power and I'll hopefully be well informed when I get to the age at which anti coagulation must be considered. Next question, I suppose, would be: what percentage of the AF sufferers who went on to have strokes in the Framlingham Study were taking 'blood thinners' at the time of their stroke? And how was the severity of strokes affected in those patients?
I saw a figure of over 50% of strokes were prevented by anticoagulants (which was just warfarin then). Separately I've seen figures that strokes on anticoagulants tend to be less severe.
Thanks. I guess we could postulate all day long about how different factors alter the stats. Anyone wanting to frighten themselves could work out that since the incidence of stroke is 1 in 6 in the UK, then multiplying that by 5 would give an 83% likelyhood of stroke for every AF patient.
That's flawed logic and the mathematical reality is different of course; we know what a 'mongrel' condition it is, and one person's potential for stroke is not the same as the next.
All sorts of factors such as severity of condition, lifestyle, diet, co-morbities, genetics, quality of care, environment etc feed into an individual's potential, and as valuable a resource as it is, and something we must all take seriously, the blanket approach of statisticians can't quantify individual risk.
I also wonder whether TIA's are included in the stroke total. I know several people who've had one or more of these and been unaffected other then the short-term symptoms.
I also know 3 guys, all in their 80s and all long term AF sufferers, none of whom have ever had a stroke.
There's a stat I do like! 😁 But I know not to be complacent.
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