Clot-busting medicine safe for use in warfarin-treated patients following stroke
The clot-busting medicine, tPA (tissue plasminogen activator), is safe to use in acute stroke patients already on the home blood thinner warfarin, according to researchers from Duke Clinical Research Institute (DCRI). This study helps allay previous concerns that tPA was too dangerous to use in patients on home anticoagulation and would lead to high risk for potentially fatal intracranial bleeding.
"To date, we have no randomized trials or large cohort studies to guide us," says Ying Xian, M.D., Ph.D., assistant professor of medicine at Duke, and first author of the study published today in JAMA. "Our large national study found no statistically significant increase in risk, which supports using intravenous tPA in warfarin-treated patients following stoke if their INR is less than or equal to 1.7."
The Duke researchers also found almost half of warfarin-treated patients who might have qualified for tPA following stroke did not receive treatment, according to DCRI Director Eric Peterson, M.D., the paper's senior author. "We noted a substantial under-treatment of patients on warfarin who were eligible, but did not receive tPA following their stroke."
Warfarin is an anticoagulant proven to reduce the rate of stroke in patients with atrial fibrillation irregular heart beats. If warfarin treatment fails and the patient suffers a stroke, tPA is the only effective treatment. However, it also carries an increased risk of symptomatic intracranial hemorrhage (sICH).
American Heart Association guidelines say IV tPA in warfarin-treated patients may be used if the INR is less than or equal to 1.7, but few small studies supported the guidelines.
The Duke observational trial included 23,437 stroke patients on warfarin treated at 1,203 hospitals, making it the largest to look at IV tPA use in warfarin-treated patients following stroke. While warfarin-treated patients had slightly higher crude rates of intracranial bleeding (5.7% vs. 4.6%) than non-warfarin patients, they were also older. After adjusting for age, stroke severity and other factors, warfarin and non warfarin users had similar intracranial hemorrhage risk.
"This study provides support for the current treatment guidelines," says Xian, and indicates that a portion of the population is being under-treated.
It also leaves several questions unanswered. "More studies are needed to look at tPA use in patients with an INR greater than 1.7, as well as in those who are taking one of the newer warfarin alternative anticoagulants (dabigatran and rivaroxiban)," Xian said.
Journal reference: Journal of the American Medical Association
Provided by Duke University Medical Center
- Clot-busting drug safe for stroke patients taking blood thinner May 10, 2012 | not rated yet | 0
- Warfarin users appear more likely to develop brain bleeding following stroke treatment Mar 08, 2010 | not rated yet | 0
- Blood-Thinning Drug Linked to Increased Bleeding in Brain Sep 29, 2008 | not rated yet | 0
- Warfarin related to low rate of residual stroke in patients with atrial fibrillation Mar 26, 2012 | not rated yet | 0
- Warfarin and aspirin are similar in heart failure treatment Feb 03, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Relating physics forces and entropy
21 minutes ago Consider proton and electron are seperated in space at some finite distance.Now suppose they released then the decrease in potential energy equals...
Force Between Two Concentric Solenoids
3 hours ago Imagine a finite length solenoid with outer radius R1 and inner radius R2. This solenoid has a time-varying current going though it. This solenoid is...
Synchrotron, question about insertion devices and electron velocity
4 hours ago When an electron enters an insertion device (wiggler and undulator) from the storage ring in a synchrotron the tangential velocity is equal to the...
Equating differentials => equating coefficients
5 hours ago Hi all, In thermodynamics one often has equations like A dx + B dy = ∂f/∂x dx + ∂f/∂y dy From which follows A = ∂f/∂x B = ∂f/∂y
The idea behind a reverse shock
11 hours ago So in a supernova explosion for example (5th slide) http://www.astro.princeton.edu/~burrows/classes/541/blastwavesChisari.pdf Ambient medium is...
Guass's Law for a charge distribution
11 hours ago First, this is not a homework question, just something I've been confused about for some time. I understand how to use Guass's law in many ways but...
- More from Physics Forums - Classical Physics
More news stories
Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...
Cardiology 17 hours ago | not rated yet | 1
Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...
Cardiology 17 hours ago | not rated yet | 0
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...
Cardiology 17 hours ago | 5 / 5 (3) | 5
Transcatheter aortic valve implantation (TAVI) is effective and safe in Asian patients, according to early experience based on first results from a multicentre Asian registry reported at EuroPCR 2013.
Cardiology May 24, 2013 | not rated yet | 0
Routinely measuring fractional flow reserve (FFR) using pressure wire assessment during coronary angiography for diagnosis of chest pain leads to significant changes in the management of one in four patients, according to ...
Cardiology May 24, 2013 | not rated yet | 0
(HealthDay)—Animals make great companions for senior citizens, but elderly people who always drive with a pet in the car are far more likely to crash than those who never drive with a pet, researchers have ...
9 hours ago | not rated yet | 1
(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...
16 hours ago | not rated yet | 0
(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.
May 20, 2013 | 4.8 / 5 (30) | 9 |
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
May 22, 2013 | 5 / 5 (4) | 6 |
Salamanders' immune systems are key to their remarkable ability to regrow limbs, and could also underpin their ability to regenerate spinal cords, brain tissue and even parts of their hearts, scientists have ...
May 20, 2013 | 4.9 / 5 (7) | 5 |
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
May 24, 2013 | 4 / 5 (4) | 4 |