Daily pill could curb death toll from blood clots after surgery

A daily pill that could help to prevent tens of thousands of deaths due to blood clots will be available to hospitals within weeks.

The condition, venous thrombo-embolism (VTE), causes one in ten fatalities in hospital and kills at least 25,000 people in England every year, more than 20 times the number of deaths attributed to the superbug MRSA.

Pradaxa, the first new blood-thinning treatment in more than 50 years, is set to receive its licence next month. It will be used initially after hip and knee replacement surgery when the risk of blood clotting is high. But doctors hope that the anticoagulant pill could also be used to treat thousands of other patients at risk from heart conditions and strokes.

As many as half of all patients going into hospital risk developing VTE, which occurs when part of a deep-vein thrombosis or blood clot migrates to the lungs, heart or brain, with potentially deadly consequences.

Such clotting is common after surgery, especially in the elderly, the overweight or those confined to bed for more than three days.

Last year the National Institute for Health and Clinical Excellence (NICE) issued guidelines recommending that all patients should be assessed on admission to hospital for their risk of developing VTE but an audit by the all-party parliamentary thrombosis group in November found that less than a third of hospitals were doing so.

Of those who were screened, only half the patients deemed at risk were receiving preventive treatment, a study published in The Lancet last month suggested.

A report by Sir Liam Donaldson, the Chief Medical Officer, admitted that “there was no systematic approach to identifying and treating those patients at risk from blood clots in hospitals and that there was significant room for improvement”.

At present, many hospital patients at risk of blood clots are given warfarin, which was licensed in the 1950s. Warfarin is effective but can trigger excessive internal bleeding. An alternative drug, heparin, involves a lengthy course of injections.

Preliminary results from a trial involving 34,000 patients suggest that Pradaxa is as effective in preventing clotting as existing treatments but it should be cheaper and easier to take. It works by reversing and inhibiting the effects of thrombin, a protein that allows clots to form after surgery.

Produced by the German company Boehringer Ingelheim, the drug is being evaluated by NICE and if approved it could be available to NHS patients within weeks.

Another anticoagulant, Xarelto, is in development by Bayer, with preliminary results suggesting that it could be even more effective than Pradaxa.

Simon Frostick, a specialist in orthopaedics at the University of Liverpool, said: “These new drugs will revolutionise the way we prevent and treat blood clots.

“Given the new trend for shorter hospital stays following joint replacement surgery, it is becoming increasingly important to have anticoagulant treatments available which are well tolerated and easy to use.”

Beverley Hunt, medical director of the UK thrombosis charity Lifeblood, said: “The number of deaths from VTE is nothing short of a public health emergency.

“The development of new drugs to treat this problem is terribly exciting. The potential benefit to the NHS is enormous.”

Between 1995 and 2003, the NHS Litigation Authority handled more than 450 claims of negligence after patients developed VTE in hospital. It paid out almost £19 million in compensation to sufferers or their bereaved families.

Professor Frostick added: “If these drugs reduce the number of deaths, the requirement for injections and community nurses, as well as other burdens - and if the proper sums are done – they should work out to be cost-effective for the NHS.”

Source - The Times

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