Will a stroke patient need a mortgage next?

Photo from 401kcalculator.org via Flickr

We've seen lots of stories lately about drug prices. And there are lots of high-price drugs that aren't in the news a lot. Just Google "Jublia price" and you'll get stories like this one.

Now, another drug is making news - and this one is close to home for past and future stroke survivors. It seems that the long-approved clot-buster is a price-buster too:

For those keeping score, here is yet another example of drug price escalation: the cost of alteplase, aka tPA, the clot-busting agent used to treat stroke, increased by 111% from 2005 to 2014 -- but Medicare payment for the drug has increased by 8% during the same period.

A standard alteplase vial contains 100 mg, and in 2014 the cost for that vial was $6,400, said Dawn Kleindorfer, MD, of the University of Cincinnati. Kleindorfer reported the results of her cost-analysis here at the International Stroke Conference. ...

Good advice - find the balance between treatment risks and benefits

Photo from U.S. Centers for Disease Control and Prevention

Now, as Paul Harvey used to say, the rest of the story.

I've posted quite a bit about high blood pressure as a stroke risk. It's the leading cause of strokes.

A wise doctor, as part of taking care of my aging mother a few years ago, described health decisions about her as a balancing act. Take this medication, and it might affect that ailment, which might affect other medication, and so on and so on. Truer words were never spoken.

Now, here's some thoughts to consider about high blood pressure, new targets and possible medication side affects, in an article stating that new blood pressure guidelines a danger to patients:

Too many drugs for older patients?

Last blog post was about young people. Now, news about the older set.

A thought-provoking article asking the question Are oldest patients getting too many drugs?:

Photo from National
Institutes of Health

"The data strongly suggest that we are overtreating many healthy patients aged 80+ regarding stroke prevention," he wrote.

"We need actively to rethink our priorities and beliefs about stroke prevention, actively informing and involving the views of the key person, the patient," he wrote. "Most of the patients will probably eschew the modest potential benefit, preferring the reduced burden of polypharmacy and side effects judged as 'minor' by the prescriber."

In the last few years of my mother's life, a wise physician told us that there's quite a balancing act about prescribing medicines for older people. Drugs can interact and interfere with each other. This is definitely a topic to have a serious conversation at the right time.

Developing new class of blood thinners continue

For a few years, I took warfarin (also known as Coumadin) daily. I had to be careful in diet, in the timing of the medication and getting blood tests monthly to make sure my blood was not too thick, not too thin, but rather, to paraphrase Goldilocks, "just right."

The drug, also famously used as rat poison, has been in use to prevent clot-type strokes for decades. You might have seen the TV commercials lately for new drugs coming on the market to replace warfarin. Now, new blood thinner edoxaban was found safer, as effective as warfarin:

"Personally, I think it will be used. We know this drug is safer than warfarin," said the study's lead investigator, Dr. Robert Giugliano, a cardiologist at Brigham and Women's Hospital in Boston.

But it will enter a market that already has three other new medicines vying to displace cheap, decades-old warfarin. 

It aims to compete with Xarelto, sold by Bayer AG and Johnson & Johnson, and Eliquis sold by Bristol-Myers Squibb Co. and Pfizer Inc., which belong to the same class of drugs as edoxaban, as well as a similar medicine from Boehringer Ingelheim called Pradaxa. ...

"If you look at the four new drugs, they're more similar than different," said Dr. Mark Link, a professor at Tufts University Medical Center in Boston, who was not involved in the trial. "All these drugs are safer than warfarin."

Warfarin, of course, can cause bleeding, bruising and other medical problems. On the downside of the new drugs, costs will be far greater than the cheap generic warfarin. Still, worth discussing with your doctor.

(Photo from the National Library of Medicine)

Inexpensive drug goes through stroke prevention trial

Many more people write much  better about clinical trials than I do, so I don't do it very often.

However, I was a bit surprised by an article I ran across an upcoming trial about the drug methotrexate for stroke prevention. Why? In at least one of its form, it's cheap. I have a relative who took  it for rheumatoid arthritis, and the cost was nominal.

So, I hope there is some success in the use of this potentially inexpensive medication. Not a bad idea to check back on its progress from time to time, especially through your own doctor.

Here's a link to a MedPage Today article and a small excerpt:

"We believe that the concept of reducing inflammation has enormous potential as a new method to reduce the burden of heart attack and stroke for our patients," Ridker said in a press release.

Selection of the planned 350 to 400 sites for the trial is to begin in November, with patient recruitment in the U.S. and Canada to get under way in March 2013, according to an NHLBI statement.

Methotrexate, an antifolate drug, has powerful anti-inflammatory properties. It's the standard disease-modifying drug for rheumatoid arthritis and psoriasis. At higher doses, the drug suppresses cell proliferation and is used to treat various cancers.

Another stroke prevention drug

Atrial fibrillation is a common cause of stroke, as mentioned before. The U.S. Food and Drug Administration just approved a new drug for stroke prevention for those patients. Stroke is the third leading cause of death in the United States and is the leading cause of permanent disability.

FDA approves Pradaxa to prevent stroke in people with atrial fibrillation

The U.S. Food and Drug Administration today approved Pradaxa capsules (dabigatran etexilate) for the prevention of stroke and blood clots in patients with abnormal heart rhythm (atrial fibrillation).

Atrial fibrillation, which affects more than 2 million Americans, involves very fast and uncoordinated contractions of the heart’s two upper heart chambers (atria) and is one of the most common types of abnormal heart rhythm.

“People with atrial fibrillation are at a higher risk of developing blood clots, which can cause a disabling stroke if the clots travel to the brain,” said Norman Stockbridge, M.D., Ph.D., director of the Division of Cardiovascular and Renal Products in the FDA’s Center for Drug Evaluation and Research.

 (Image from National Institutes of Health)

Now, a 'don't fall for this' warning

One of my standard Google alerts found a link - which I won't share - that purportedly offered a medication called Aggrenox without a prescription.

That's one of the drugs - similar to Plavix - that is a potential stroke prevention tool. I was on Plavix for years and on Aggrenox for a short time before the heart procedure took me off prescription drugs entirely.

But criminal Web sites and e-mails offering potentially dangerous drugs sans prescription abound. They prey on people who need actual medical attention.

You shouldn't self-prescribe drugs like Aggrenox or Plavix. Ever.

Avoiding a second stroke - efforts needed

A recent article in U.S. News and World Report:

After suffering a stroke, the chances of having another are high, but a new report shows many patients aren't getting the interventions they need to reduce that risk.

Those interventions include lifestyle changes, such as smoking cessation and exercise, and medical treatments, such as aspirin, blood pressure medications and cholesterol-lowering drugs.

We need more and better strategies for these patients - rehab, counseling, medication, among other things. This Stroke Awareness Month is a good time to start.

Cautionary note about mixing drugs, supplements

An article from MayoClinic.com recently gives a needed warning, starting with a question: Is it safe to take ginkgo with ibuprofen? Answer: Probably not.

The reason, wrote Mayo Clinic hypertension specialist Sheldon Sheps, M.D.:

Ibuprofen (Advil, Motrin, others) is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs can impair blood clotting, typically by blocking the ability of platelets to form clots. Ginkgo — a dietary supplement used to treat memory problems, dementia and various other conditions — may also affect the clotting process. Bleeding may be a particular concern when ginkgo is taken with other medications that can affect bleeding, such as ibuprofen. In fact, at least one fatality has been linked to the use of ginkgo and ibuprofen.

Gingko, of course, is appealing to many stroke survivors at first blush because of it's supposed powers of helping with concentration. But many are on blood thinners far more aggressive than ibuprofen. In fact, we've got a link to a study reported not long ago. But please, talk to your doctor and pharmacist before taking any supplement. This kind of mistake can kill.

Good news, but be cautious

Several blogs and other sources have played up news from a study written up in the journal Stroke:

Mice receiving a ginkgo biloba extract after a stroke - induced in a laboratory - suffered abouthalf the damage in mice who did not receive the extract. From one blog, here's a summary:

Extract from the leaves of the ginkgo tree offers promise to minimize brain damage caused by a stroke, scientists said on Thursday.

Mice given daily doses of ginkgo biloba extract before having a stroke induced in the laboratory suffered only about half the damage as animals not given it, researchers at Johns Hopkins University in Baltimore wrote in the journal Stroke.

Mice who did not get ginkgo before a stroke but were given it five minutes after a stroke sustained nearly 60 percent less damage in the day after the stroke than those not given ginkgo. And mice given ginkgo 4-1/2 hours after a stroke had about a third less damage than those not given ginkgo.

So this is promising news - something to follow.

One caveat, though - this isn't your over-the-counter gingko biloba. This supplement is widely marketed as a pill to help your memory and concentration. They also could interact - and not in a good way - with prescription medication for stroke prevention. Those would include warfarin, Plavix and Aggrenox.

So if you want try the supplement, talk to your doctor. For your health and safety.

Translating language about stroke terms

Sometimes, you just need to know what the experts are talking about. So here are some definitions of common terms used by stroke doctors brought by the Stroke section of About.com.

The Web page talks about stroke signs, medication, stroke types, stroke location and more. More and more people - for good or ill - research their own or loved ones conditions on the Web, and here's a reliable resource.