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(Health Rounds is published Tuesdays and Thursdays. Think your friend or colleague should know about us? Send them this newsletter. They can also subscribe here By Nancy Lapid
Hello Health Rounds readers! Today we present a trial showing that medications to prevent blood clots are not all the same when diabetic patients undergo artery-clearing procedures. We also present a study on anesthesia which should reassure women who give birth by cesarean section.
Blood thinners are not as effective for diabetic patients after heart surgery
Blood thinners that doctors often prescribe interchangeably after procedures to reopen narrowed heart arteries do not have the same effectiveness in diabetic patients, an Indian study suggests.
All 1,800 study participants had type 1 or type 2 diabetes and underwent minimally invasive procedures to clear a blocked coronary artery and open it using a drug-coated stent to reduce the risk of re-blockage.
Then they received aspirin plus AstraZeneca’s Brilinta (ticagrelor) or Effient (prasugrel), sold by Eli Lilly LLY.N and Daiichi Sankyo 4568.T , a class of drugs known as P2Y12 inhibitors that are prescribed to prevent blood clots.
The combined rate of heart attack, stroke, bleeding complications or death was 16.6% in the ticagrelor group and 14.2% in the prasugrel group, researchers reported at the American Heart Association Scientific Sessions held recently in New Orleans.
The trends were similar when rates of nonfatal heart attack, major hemorrhage, and death were analyzed separately.
“For people with type 1 or type 2 diabetes and complex coronary artery disease, treatment with prasugrel may have an advantage over ticagrelor,” study leader Dr. Sripal Bangalore of the NYU Grossman School of Medicine, study leader, said in a statement.
“We were surprised by the results because we had hypothesized that ticagrelor should be as good as, or better than, prasugrel,” he added. “It is important to choose the right drug and, at least based on our data, we cannot say that ticagrelor and prasugrel are interchangeable.”
General anesthesia appears safe for cesarean sections
General anesthesia is a reasonable option for women who give birth by cesarean section, especially when spinal or epidural nerve blocks are ineffective, according to a new analysis.
Up to one in six women who receive regional anesthesia during a C-section may experience pain, and for some, the pain can be excruciating, but general anesthesia has long been avoided because of concerns about its effects on the baby, the researchers noted in a report of their study in Anesthesiology.
They analyzed 30 years of data from dozens of randomized trials involving nearly 3,500 children born by cesarean section. About half of the surgical procedures were performed under general anesthesia.
Although babies born under spinal or epidural anesthesia had slightly higher Apgar scores – a measure of newborn health – than those born under general anesthesia, the differences were small and unlikely to be clinically significant, the researchers found.
They also found that babies born under general anesthesia were slightly more likely to need respiratory support immediately after birth, but there was no increase in neonatal intensive care unit admissions.
The research does not suggest that general anesthesia should replace localized techniques, but it may be a reasonable option in some cases, the authors said.
“Because regional anesthesia is so widely used, it is common for patients to think that a spinal or epidural block is the only safe option for a cesarean section,” Dr. Mark Neuman of the University of Pennsylvania Perelman School of Medicine, leader of the study, said in a press release. “But as our study shows, the type of anesthesia during pregnancy does not need to be a one-size-fits-all approach.”
