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Watch Video: Unveiling the Power of Blood Thinners – How They Protect Your Heart and Brain

by Dr. Shruthi R August 13, 2024

written by Dr. Shruthi R

Blood Thinner Medicines: The purpose of blood thinners is to maintain blood flow and reduce the risk of clots forming, which can lead to serious conditions such as heart attack and stroke. Thickening of the blood can cause blockage in the arteries, which can cause damage to the heart and brain.

Blood thinner medicines, often referred to as anticoagulants or antiplatelet drugs, play a crucial role in managing and preventing serious health conditions associated with blood clotting. Their primary purpose is to maintain smooth blood flow throughout the circulatory system and reduce the risk of clot formation that could potentially lead to life-threatening conditions such as heart attacks, strokes, and deep vein thrombosis (DVT). Understanding these medications involves exploring their purpose, types, mechanisms, benefits, risks, and how they fit into the broader context of cardiovascular health.

Purpose of Blood Thinners

Blood thinners are designed to prevent the formation of abnormal blood clots or to treat existing clots that could otherwise obstruct blood flow. Clot formation, or thrombosis, can be detrimental when it occurs in vital blood vessels, potentially leading to severe health issues. For instance:

Heart Attack: When a clot forms in one of the coronary arteries, it can block blood flow to the heart muscle, causing a heart attack (myocardial infarction).
Stroke: A clot can travel to the brain, blocking blood flow and causing a stroke (cerebrovascular accident).
Deep Vein Thrombosis (DVT): Clots can form in the deep veins, usually in the legs, and may break off and travel to the lungs, causing a pulmonary embolism.
Pulmonary Embolism (PE): A blockage in one of the pulmonary arteries in the lungs caused by a blood clot that traveled from elsewhere in the body.

By reducing the blood’s ability to clot, these medications help mitigate these risks and improve overall cardiovascular health.

Types of Blood Thinners

Blood thinners can be broadly classified into two categories: anticoagulants and antiplatelet drugs.

Anticoagulants
Anticoagulants work by interfering with the blood clotting process, making it more difficult for clots to form. They are often prescribed to individuals with conditions that increase their risk of developing clots. Key anticoagulants include:
- Warfarin (Coumadin): One of the oldest and most commonly used anticoagulants, warfarin works by inhibiting vitamin K, which is necessary for the synthesis of clotting factors in the liver. Patients on warfarin need regular blood tests (INR tests) to monitor their blood clotting levels.
- Direct Oral Anticoagulants (DOACs): These newer medications, including rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa), and dabigatran (Pradaxa), target specific proteins in the blood clotting process. They generally require less frequent monitoring than warfarin and have fewer dietary restrictions.
- Heparin: Administered via injection, heparin works quickly to inhibit clot formation. It is often used in hospital settings for short-term management of acute clotting conditions or during surgery. Low molecular weight heparins (LMWH) like enoxaparin (Lovenox) are also used for outpatient treatment and offer a more predictable effect.
Antiplatelet Drugs
Antiplatelet drugs prevent blood cells called platelets from clumping together to form clots. These medications are often used to prevent heart attacks and strokes, particularly in individuals with a history of cardiovascular disease. Common antiplatelet drugs include:
- Aspirin: Perhaps the most well-known antiplatelet medication, aspirin inhibits an enzyme called cyclooxygenase (COX), reducing platelet aggregation. It is commonly used for cardiovascular disease prevention.
- Clopidogrel (Plavix): This medication prevents platelets from sticking together by blocking a specific receptor on platelets. It is often prescribed to patients with coronary artery disease or after certain types of heart procedures.
- Ticagrelor (Brilinta) and Prasugrel (Effient): These are newer antiplatelet agents that also prevent platelets from clumping but may have different efficacy and safety profiles compared to clopidogrel.

Mechanism of Action

Understanding the mechanism of action of blood thinners is essential for grasping their role in managing clot-related conditions:

Anticoagulants: These drugs generally work by interfering with the blood clotting cascade, a series of chemical reactions involving clotting factors. For example, warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, and X), while DOACs specifically target factors Xa or thrombin to prevent clot formation.
Antiplatelet Drugs: These medications prevent platelets from aggregating or sticking together. Aspirin inhibits COX-1, reducing the production of thromboxane A2, a substance that promotes platelet aggregation. Other antiplatelet drugs target different receptors or pathways involved in platelet activation.

Benefits of Blood Thinners

Blood thinners provide several benefits:

Prevention of Heart Attacks and Strokes: By reducing clot formation, these medications lower the risk of heart attacks and strokes, significantly improving patient outcomes in those with cardiovascular disease or risk factors.
Treatment of Existing Clots: For patients with existing clots, such as in cases of DVT or PE, blood thinners can prevent the clot from growing and reduce the risk of complications.
Improved Quality of Life: By preventing the occurrence of severe clotting events, blood thinners help maintain better overall health and reduce the need for emergency interventions.

Risks and Considerations

While blood thinners are highly effective, they come with risks and considerations:

Bleeding Risk: The most significant risk associated with blood thinners is bleeding. Patients may experience minor bleeding, such as nosebleeds or bleeding gums, or more severe bleeding, including gastrointestinal or intracranial hemorrhages. Regular monitoring and dose adjustments are crucial to minimize this risk.
Drug Interactions: Blood thinners can interact with various medications, including over-the-counter drugs and supplements. For example, combining blood thinners with nonsteroidal anti-inflammatory drugs (NSAIDs) or certain antibiotics may increase bleeding risk.
Dietary Restrictions: Some blood thinners, particularly warfarin, require dietary restrictions. Foods high in vitamin K, such as leafy green vegetables, can interfere with the medication’s effectiveness. Patients must maintain a consistent intake of such foods and have regular INR monitoring.
Monitoring Requirements: While newer anticoagulants generally require less monitoring, traditional medications like warfarin necessitate regular blood tests to ensure therapeutic levels are maintained.

Patient Management and Lifestyle Adjustments

Effective management of blood thinners involves a combination of medication adherence, lifestyle adjustments, and regular medical follow-ups:

Adherence to Medication: Consistent use of prescribed blood thinners is crucial for preventing clot-related events. Missing doses or altering the dosage without medical advice can increase the risk of complications.
Regular Monitoring: Patients on warfarin need frequent INR tests to ensure their blood is within the therapeutic range. For those on newer anticoagulants, periodic check-ups are still important to assess kidney function and overall health.
Lifestyle Adjustments: Patients should adopt a healthy lifestyle that includes a balanced diet, regular exercise, and avoidance of activities that may increase bleeding risk. They should also inform all healthcare providers about their blood thinner use before any medical procedures or surgeries.

Blood thinner medicines are vital tools in preventing and managing conditions related to abnormal blood clotting. By maintaining proper blood flow and reducing the risk of clot formation, these medications help mitigate serious health risks such as heart attacks, strokes, and pulmonary embolisms. While they offer significant benefits, their use requires careful management, monitoring, and lifestyle adjustments to balance efficacy with safety. Ongoing research and advancements in medication options continue to improve patient outcomes and quality of life in the realm of cardiovascular health.

August 13, 2024 0 comment

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FDA rejects Eli Lilly, Innovent’s China-developed lung cancer medication

by Medically Speaking March 25, 2022

written by Medically Speaking

The second shoe has dropped in Eli Lilly and Innovent Biologics’ effort to bring a cancer treatment developed in China to the US market.

The two businesses said Thursday that the FDA has rejected the PD-1 inhibitor sintilimab (Tyvyt in China) in newly diagnosed nonsquamous non-small cell lung cancer. The comprehensive response letter follows the FDA’s and an external expert panel’s highly unfavourable evaluations.

In keeping with the FDA’s previous stance on the application, the agency proposes that the partners conduct an additional worldwide clinical study. According to the FDA, the current trial should demonstrate that the combination of Tyvyt and chemotherapy works at least as well as standard of care in terms of prolonging patients’ lives.

According to the statement, Lilly and Innovent are “evaluating future actions for the sintilimab initiative in the United States.”

Lilly and Innovent utilised the phase 3 ORIENT-11 study, which was only done in China, for Tyvyt’s application. The Tyvyt-chemo combination was compared to chemo alone in Chinese patients with newly diagnosed nonsquamous NSCLC. As its primary aim, the study employed the progression-free survival marker, which measures how well a medication can halt tumour progression or mortality.

Tyvyt’s fate was spelled out for it in hindsight when Richard Pazdur, M.D., director of the FDA’s Oncology Center of Excellence, penned an article in The New England Journal of Medicine in December questioning the use of clinical data generated solely or predominantly in China to seek U.S. approvals.

The FDA scolded Lilly and Innovent for losing sight of trial variety, echoing Pazdur’s piece and a subsequent Lancet Oncology article. The FDA also criticised the study’s comparison arm and trial design, pointing out that PD-1 treatment has already established the standard of care in the United States after demonstrating a life-extension benefit over chemotherapy on the gold-standard overall survival measure.

Adding another twist to the process, Lilly said on the day of a scheduled FDA advisory committee meeting in February that if Tyvyt is authorised, it will be priced at a 40 percent reduction over current PD-1s. The strategy plainly failed, given the FDA does not consider drug pricing in its evaluations.

The FDA’s oncology experts ultimately voted 14-1 against approval in its present form, instead requesting that Lilly and Innovent conduct a new clinical trial. The lone “no” vote was made by Jorge Nieva, M.D., of the University of Southern California, who did point out that the availability of so-called “me-too” medications might bring down costs.
Meanwhile, several PD-1/L1 inhibitors produced in China with possibly reduced price tags are lined up at the FDA’s door. Some intended to join the lucrative U.S. market with China-only data after Pazdur basically advocated such a strategy during a gathering of the American Association for Cancer Research in 2019.

Coherus Biosciences and Junshi Biosciences are awaiting an FDA ruling on toripalimab, a PD-1 inhibitor authorised in China, for nasopharyngeal cancer. The application is likewise based only on data from China, although the disease’s rarity and prevalence in Asian populations may qualify the medicine for what the FDA calls “regulatory flexibility.”

Furthermore, the FDA’s additional criteria, such as comparing a latecomer to an established PD-1 in front-line NSCLC, have generated concerns about a large portfolio of candidates, according to SVB Leerink analyst Daina Graybosch, Ph.D.

The FDA’s rejection represents a blow for Lilly’s growing cancer portfolio. Innovent, on the other hand, is reliant on getting into the US market to continue growth.

“Throughout the registrational process, the company has gained tremendous experience and know-how, and established a strong registration team, allowing the company to be more confident and committed to bringing our innovative drugs to global markets through a defined pathway,” Innovent said in a statement.

March 25, 2022 0 comment

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Prescribes Raids on Erring Pharma Firms, Health Ministry has asked the DCGI to rid India of low-quality medicines

by Medically Speaking Team March 17, 2022

written by Medically Speaking Team

According to News18.com, the Narendra Modi administration is considering a major effort to begin surprise inspections of pharmaceutical companies’ production sites whose medications have failed quality assessments more than twice in the last year. According to government sources familiar with the situation, the office of union health minister Mansukh Mandaviya has directed the Drugs Controller General of India (DCGI) to “make India free of spurious and poor quality medicines.”

The health ministry has requested that VG Somani, the drug regulator, organise a task team to investigate the facilities across states.

“Now that India has recovered from the Covid-19 outbreak and has a high immunisation coverage, we feel India is secure.” “It’s time to move on to other endeavours, such as cleaning up the Indian medicines business of counterfeit and low-quality items,” a top government source told News18.com. “The health minister has taken the initiative, and he has directed the DCGI to look for pharmaceutical corporations whose medications are failing quality checks on a regular basis.”

KEEPING CHECK

The government inspects pharmaceuticals on a regular basis to assess if they are of acceptable or unacceptable quality (NSQ). The Central Pharmaceuticals Standard Control Organisation, the country’s main drug regulatory organisation, keeps a list of these drugs up to date on their website (CDSCO). In January, for example, 1,227 samples were analysed, with 27 medicines being designated NSQ. “Approximately 2% of the total samples gathered failed the audit, necessitating prompt care,” the officer stated. These goods failed the test for a variety of reasons, including dissolution, disintegration, and chemical content homogeneity.

The problem was noted in a study released in 2019 by the United States Trade Representative (USTR), which claimed that about 20% of all pharmaceutical items supplied in India are counterfeit or spurious.

Given India’s rapidly developing pharmaceutical sector and its decades-long reputation as the “pharmacy of the world,” this was seen as a damning assertion.

WHAT IS THE PLAN?

The DCGI office is expected to form a task group, as requested by the minister, according to a top government official.

“The minister’s office has asked the DCGI to go after all pharmaceutical companies that produce low-quality pharmaceuticals on a regular basis.” The government’s new goal is to rid India of fake medications, according to the official.

The task force, which will be created under the DCGI, will be responsible for a variety of tasks, including raiding manufacturing locations, verifying for compliance with production standards, and collecting samples from the sites.

“The manufacturer will be seriously penalised if these samples fail to pass the inspections,” the source stated.

March 17, 2022 0 comment

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Stimulants produced in India and Covid medicines are most common illegal imports in Switzerland

by Medically Speaking February 22, 2022

written by Medically Speaking

A substantial quantity of illegally imported drugs from India have been discovered in Switzerland, including medicines linked to the COVID-19 epidemic, such as ivermectin and hydroxychloroquine, as well as sexual stimulants, according to a Swiss government agency.

The Swiss Agency for Therapeutic Drugs (Swissmedic) revealed in its annual report that it and customs authorities confiscated 9,421 parcels containing unlawfully imported pharmaceutical products in 2021, up from 6,733 such packages in 2020.

The majority of the products seized were potency preparations and accounted for around 77 per cent of the confiscated packages. Other preparations secured included prescription-only medicines, such as hormones and anti-inflammatories (17 per cent) or sleeping tablets and tranquillisers (5 per cent).

Around 150 of the packages that were seized were connected with the COVID-19 pandemic. These contained prohibited quantities of prescription-only medicinal products, including anti-parasitics containing ivermectin, medicinal products containing hydroxychloroquine or antibiotics from India.

Swissmedic said Poland has overtaken the countries of Asia to become the first European country to top the country-of-origin rankings.

However, the contents of the packages of potency preparations from Poland that were seized were all erectile stimulants manufactured in India. Swissmedic suspects that new illegal distribution channels have been set up after the authorities successfully shut down the transit route via Singapore in October 2020 as part of an internationally coordinated operation.

India directly accounted for 12 per cent of total seized packages, down from 20 per cent in 2022 and from 43 per cent in 2019.

“Half of the illegally sold preparations do not contain what they claim to contain! Taking medicinal products that have been ordered without a prescription or with a sham online prescription is dangerous to health,” Swissmedic said.

February 22, 2022 0 comment

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Aspirin adverse effects include ‘unexplained bleeding’

by Medically Speaking December 13, 2021

written by Medically Speaking

Aspirin is a sort of pain reliever that is commonly used to treat minor pain and discomfort, such as headaches and period cramps. It can also be used to treat the symptoms of a fever. However, there are certain negative effects, like with other medicines. There is one adverse effect about which you should consult a doctor if you begin to notice it.

Before you use aspirin or recommend it to someone else, check sure you can do so securely.

You should also let your GP know if you:
• Are pregnant
• Have an allergy to aspirin
• Have ever had a stomach ulcer
• Suffer from high blood pressure
• Suffer from indigestion
• Suffer from asthma
• Have heavy periods
• Have ever had liver or kidney problems.
• Have ever had a blood clotting problem
• Have gout (a form of arthritis)

On that first point, about pregnancy, there are some guidelines about whether and how much you should take during your term.

Overall, it is agreed that it is safe to take aspirin during your pregnancy, as long as your GP gives you the go ahead.

The reason why aspirin may be prescribed is to lower your chances of a heart attack or a stroke, if you’re having fertility treatment or if you have experienced previous miscarriages.

It can also help to prevent pre-eclampsia, a type of high blood pressure that occurs during pregnancy.

Aspirin works best when used over long periods of time and, unlike some medicines, you can continue to drink alcohol whilst taking it.

Whilst it’s safe to take painkillers with aspirin, it’s recommended that you avoid taking ibuprofen, that is unless you’ve consulted your GP or doctor beforehand.

The reason for avoiding taking both together is that, combined, they can cause stomach irritation.

Lifestyle changes can also be made to enhance the effect of the aspirin; these include improving your diet, exercising more, cutting down on your alcohol levels and finding ways to reduce stress and anxiety.

It is not safe for youngsters to use aspirin, for example.

December 13, 2021 0 comment

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Merck Approves Generic Manufacturing of Its COVID Pill, Molnupiravir

by Medically Speaking October 28, 2021

written by Medically Speaking

Merck announced on Wednesday a collaboration with the UN-backed Medicines Patent Pool (MPP) that will allow more companies to produce generic versions of its COVID-19 pill.

The licencing agreement will make molnupiravir, Merck’s antiviral medication developed in collaboration with Ridgeback Biotherapeutics, available to millions of people in developing countries.

What is the deal about?

Under the agreement, Merck grants a license to MPP which can then sub-license to manufacturers of generic drugs.

MPP is a Geneva-based international organisation backed by the UN that works to facilitate the development of medicines for low- and middle-income nations.

The royalty-free license would apply to 105 such countries.

This means that Merck will not receive sales royalties while COVID-19 remains classified as a ‘public health emergency of international concern’ by the World Health Organisation.

“This is the first transparent, public health-driven voluntary license for a COVID-19 medical technology,” Merck and MPP said in a joint statement.

What is the antiviral pill?

Molnupiravir, an experimental oral antiviral pill, has been found to reduce the risk of serious disease and death by 50% when given within days of a positive test, according to phase three clinical trials.

No deaths were reported in patients who received the pill, while eight deaths had been recorded in patients who received a placebo.

“The interim results for molnupiravir are compelling and we see this oral treatment candidate as a potentially important tool to help address the current health crisis,” said MPP executive director Charles Gore.

The US Food and Drug Administration and the European Medicines Agency are already reviewing the drug, and a decision could come within weeks.

Earlier this year, Merck signed bilateral licensing deals with eight Indian generic drug makers, including Cipla, Dr Reddy’s Labs and Sun Pharmaceuticals, among others.

“We all along knew that we would want to diversify the geographic footprint of our generic partners so that we did not only have generic suppliers in India but in other geographies as well,” Paul Schaper, Merck’s executive director of global public policy, told Reuters news agency.

October 28, 2021 0 comment

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A common antidepressant should not be used to treat dementia patients, according to a new study

by Medically Speaking October 23, 2021

written by Medically Speaking

According to a new study, a medicine used to treat agitation in patients with dementia is no more beneficial than a placebo and may potentially increase mortality. The study, headed by the University of Plymouth and published in The Lancet, found that the antidepressant mirtazapine had no effect on agitation in persons with deMENTIA and was perhaps more likely to be linked to death than no intervention at all.
Agitation is a frequent sign of dementia that is marked by excessive verbal, vocal, or motor activity, as well as physical and verbal hostility. The primary solution should be non-drug patient-centered treatment, but if that doesn’t work, physicians may turn to a drug-based option.

Antipsychotics have proven to increase death rates in those with dementia, along with other poor outcomes, and so mirtazapine has been routinely prescribed. This study was designed to add to the evidence base around its effectiveness.

Funded by the National Institute for Health Research (NIHR), the study recruited 204 people with probable or possible Alzheimer’s disease from 20 sites around the UK, allocating half to mirtazapine and half to placebo. The trial was double-blind; meaning that neither the researcher nor the study participants knew what they were taking.

The results showed that there was no less agitation after 12 weeks in the mirtazapine group than in the control group. There were also more deaths in the mirtazapine group (seven) by week 16 than in the control group (only one), with analysis suggesting this was of marginal statistical significance.

Lead researcher Professor Sube Banerjee, Executive Dean of the Faculty of Health and Professor in Dementia at the University of Plymouth, explained why the results were so surprising but important.

“Dementia affects 46 million people worldwide – a figure set to double over the next 20 years. Poor life quality is driven by problems like agitation and we need to find ways to help those affected,” he said.

This study shows that a common way of managing symptoms is not helpful – and could even be detrimental. It’s really important that these results are taken into account and mirtazapine is no longer used to treat agitation in people with dementia.

“This study has added important information to the evidence base, and we look forward to investigating further treatments that may help to improve people’s quality of life,” Banerjee added.

October 23, 2021 0 comment

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BDR Pharma develops medicines against cancer cell replication

by Medically Speaking September 15, 2021

written by Medically Speaking

Mumbai: BDR Pharma, a generic company, announces that Cabozantinib can be launched, which can treat metastatic meduller thyroid, advanced renal cell carcinoma and carcinoma of the hepatocellular cell.

Cabozantinib is prescribed as a second-line treatment for renal cell Carcinoma, apart from treating hepatocellular carcinoma, in patients receiving progressive metastatic medullary thyroid (MTC) cancer. The drug works by blocking (inhibiting) the signals that grow and divide within cancer cells. CABOZANIB showed better PFS in several studies, such as Celestial (double blind Phase III), Phase III meteor trials (Progression-Free Survival).

Elucidating on the efforts that went into developing the drug, Raheel Shah, Director of Business Development, BDR Pharmaceuticals, said: “World-class treatment at a reasonable rate was the main reason for launching the drug in India. Though we have been outstretched in all departments to deliver on COVID treatment on an emergency basis, we have not allowed this to hamper our efforts on other equally important priority segments, including oncology. The result is the advent of development of this new generic cancer molecule called Cabozantinib(Cabozanib). ”

As DGCI approved BDR Pharma’s Cabozantinib to be put into medicinal use, the company claimed that it will soon make it available in the market for treatment.

September 15, 2021 0 comment

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Zydus Cadila receives USFDA nod for diabetes medicines

by Medically Speaking September 6, 2021

written by Medically Speaking

The US health authorities approved Sitagliptin for marketing, which was recommended to treat diabetes, on Monday, Drug company Zydus Cadila said. The business said its affiliate obtained preliminary clearance for its new Sitagliptin Base 25, 50 and 100 mg tablets from the US Food and Drug Administration (FDA).

In an application for authorisation to commercialise Sitagliptin bases 25, 50 and 100mg tablets, Zydus submitted their new medication application to the USFDA on 31 October 2020. Once the first review cycle was completed on 2 September 2021, Zydus Cadila indicated that the NDA got preliminary clearance.

Zydus Cadila discovers, develops, manufactures, and markets a broad range of healthcare therapies including small molecule drugs, biologic therapeutics, and vaccines.

The group employs around 23,000 people worldwide. The group employs around 23,000 people worldwide.

September 6, 2021 0 comment

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The USFDA has given Zydus Cadila preliminary approval to market the cancer medication ‘Lenalidomide’

by Medically Speaking August 18, 2021

written by Medically Speaking

New Delhi, India: Zydus Cadila, a pharmaceutical company, announced on Tuesday that it has gotten conditional approval from the US Food and Drug Administration to market Lenalidomide Capsules, which are used to treat certain types of malignancies.

The US Food and Drug Administration (USFDA) has given the company provisional approval to market Lenalidomide Capsules in the strengths of 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 25 mg.

Lenalidomide is used to treat various types of cancers. It works by slowing or stopping the growth of cancer cells. It is also used to treat anemia in patients with certain blood/bone marrow disorders (myelodysplastic syndromes-MDS).

The drug will be manufactured at the group’s formulation manufacturing facility at the SEZ, Ahmedabad, the company said in a statement.

August 18, 2021 0 comment

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