Stroke patients in UK "missing out on treatment for brain clots"

Thousands of stroke patients in the UK may be missing out on a treatment that involves physically unplugging blood vessels in the brain, research suggests.

Scientists estimate that about 9,000 patients with blood clots in the brain – a tenth of the total – could benefit from mechanical thrombectomy (MT) each year. Currently, fewer than 600 patients a year undergo the procedure.

The catheter technique uses an expandable grabber or suction to clear clots from large blood vessels and is said to be more effective than relying on clot-busting drugs.

Dr Martin James, one of the researchers from the Royal Devon and Exeter hospital, said: “Delivering mechanical thrombectomy to the 9,000 people who need it will require major changes to the configuration and skill sets of existing acute stroke services.

“We must work quickly to establish what needs to be done so that more people in the UK can benefit from a treatment which can dramatically reduce disability after a stroke as well as cutting associated costs to the NHS and social care.”

The study’s authors analysed all the available results from clinical trials of the procedure and compared them with the prevalence of stroke in the UK. They concluded that large numbers of British patients who qualified for MT were not being offered the treatment.

Between 8,770 and 9,750 stroke patients admitted to UK hospitals each year stood to benefit from the procedure, said the researchers, whose findings were presented at the UK Stroke Forum Conference in Liverpool.

Very few UK hospitals have enough specialists and the necessary support to provide MT treatment 24 hours a day, they claimed.

Co-author Professor Phil White, from the University of Newcastle, said: “Mechanical thrombectomy is a highly effective treatment for acute ischaemic stroke, with eight clinical trials showing a significant reduction in disability after stroke if it is used immediately in the right patients.

“The challenge is to make this technique more widely available, as current figures suggest that fewer than 600 patients receive this treatment each year in the UK.”

Stroke patients in UK "missing out on treatment for brain clots"

Study Finds Flaws in New Therapy For Blood Clots

In current many years, catheter-directed thrombolysis (CDT) has been additional to the present common of anticoagulation treatment in some individuals with deep vein thrombosis (DVT). The hope was that CDT would support reduce the large fee of post-thrombotic syndrome (PTS), but now an observational review finds no benefits and some critical disadvantages connected with CDT.

In a report published in JAMA Internal Medicine, Riyaz Bashir and colleagues analyzed data from far more than 90,000 patients hospitalized for DVT, 3649 of whom received CDT plus anticoagulation. In-hospital mortality did not differ substantially in between the CDT sufferers and matched controls who obtained anticoagulation alone (1.two% and .9%, respectively p=.15). Nevertheless, the CDT group had drastically increased charges of pulmonary embolism, intracranial hemorrhage, and vena cava filter placement. The CDT group also had longer and more pricey hospital stays.

The authors acknowledge the limitations of observational studies and call for randomized trials “to evaluate the magnitude of the impact of CDT on outcomes such as mortality, PTS and recurrence of DVT.” They conclude that CDT “should be provided only to patients with a reduced bleeding risk. … it is essential that the magnitude of advantage from CDT be substantial to justify the increased initial resource utilization and bleeding risks of this treatment.”

John Ryan, a cardiologist at the University of Utah, provided this thoughtful perspective on the study:

This is an timely review simply because there has been an boost in CDT use with no an accompanying increase in randomized information. Nonetheless, there are some limitations in this registry that need to be highlighted- in some institutions, short-term IVC filters are positioned as portion of the CDT process, so might not automatically reflect a complication but rather can be part of the protocol. Also, if a patient already has a PE and is mentioned to have residual large burden of DVT, they could be referred for CDT to aid avert one more embolus- this, in component, may possibly account for higher charges of PE in CDT treated individuals. In spite of these issues, this registry examine identifies a lot of troubles with the increasing use of CDT, in distinct the improved chance of intracranial hemorrhage is concerning and may possibly reflect variable doses of thrombolytics. As the authors highlight we need randomized information on CDT to figure out exactly the risks and positive aspects linked with this procedure, as well as standardized approaches and dosages to this method.

Study Finds Flaws in New Therapy For Blood Clots

Pill poses threat of blood clots, GPs warned

The danger of blood clots in the veins varies between CHCs, ranging from five to twelve circumstances per 10,000 girls a 12 months, in contrast with two circumstances a year per ten,000 ladies who are not utilizing the combined pill. Photograph: Stockbyte/Getty Images

Ladies in England making use of some of the most well-known brands of contraceptive pill are to be warned that they carry a chance of fatal blood clots.

The Medicines and Healthcare Merchandise Regulatory Agency (MHRA) advised GPs the hazards posed by mixed hormonal contraceptives [CHC], which incorporate two diverse female hormones, an oestrogen and a progestogen, were small and the benefits outweighed them but that females must recognize those risks.

The tips for GPs states: “The determination to use any CHC must be taken only following a discussion with the ladies to guarantee she understands: the effect of any intrinsic chance elements on her chance of thrombosis [eg deep vein thrombosis, pulmonary embolism, heart attack and stroke] the risk of thromboembolism with her CHC that she must be alert for indications and signs of a thrombosis.”

An alert was issued by the MHRA to GPs on 22 January following the European Medicines Agency (EMA) mentioned in November that the merchandise info for CHCs containing specified synthetic progestogen must be updated.

The EMA launched a review after France’s drug security company estimated that about twenty girls die each and every 12 months in France of blood clots linked to contraceptive use.

The EMA concluded: “The benefits of CHCs in stopping undesirable pregnancies carry on to outweigh their risks, and that the nicely-acknowledged chance of VTE [venous thromboembolism] with all CHCs is tiny.”

The company found that the risk of blood clots in the veins varies amongst CHCs, ranging from five to 12 instances per 10,000 girls who use them for a year, compared with two situations every single 12 months per ten,000 ladies who are not making use of CHCs.

A checklist for prescribers offered by the MHRA says a CHC should not be prescribed to specified ladies, including people with a history of a thromboembolic event or with quite high blood pressure, people who have had significant surgical procedure, or have a time period of prolonged immobilisation coming up.

It says the suitability of a CHC need to be mentioned with a female if they have specified risk elements which includes age, obesity and smoking and that if exposed to far more than one of those threat aspects it “might mean a CHC must not be utilised”. The MHRA advises that CHCs containing ethinylestradiol, a synthetic type of oestrogen, in mixture with particular sorts of synthetic progestogen – namely levonorgestrel, norgestimate, or norethisterone – are regarded to have the lowest threat of VTE.

A user card and patient details sheet are also supplied, detailing the risk. The former says: “The overall danger of a blood clot is small but clots can be critical and could in really uncommon situations even be fatal.” Women are warned to look for quick health care attention if they experience signs and symptoms such as significant soreness or swelling in either leg, sudden unexplained breathlessness, weakness or numbness of the face, arm or leg.

Dr Sarah Branch, deputy director of the MHRA’s vigilance and danger management of medicines division, stated: “Ladies should proceed to get their contraceptive pill. These are really risk-free, hugely efficient medicines for preventing unintended pregnancy and the benefits connected with their use far outweigh the risk of blood clots in veins or arteries.”

Pill poses threat of blood clots, GPs warned