Navigation Links
Drug dosing for older heart patients should differ
Date:8/16/2013

DURHAM, N.C. Older heart patients present unique challenges for determining the optimal dosages of medications, so a new study from researchers at Duke Medicine offers some rare clarity about the use of drugs that are used to treat patients with heart attacks.

For certain heart patients older than age 75, a half-dose of the anti-platelet drug prasugrel works about as well as the typical dosage of clopidogrel, according to a team led by the Duke Clinical Research Institute that looked at a sub-study of a large clinical trial.

"As people live longer throughout the world, it's increasingly important to establish appropriate treatments for conditions such as acute coronary syndromes that commonly occur later in life," said Matthew T. Roe, M.D., MHS, associate professor of medicine at Duke and lead author of a study published Aug. 20, 2013, in the journal Circulation.

"These patients are very vulnerable to side effects, including bleeding, if therapies are not properly dosed," Roe said. "Additionally, existing practice guidelines have few specific recommendations for older patients with acute coronary syndromes as little evidence has been accrued from prior clinical trials in this population."

People older than age 75 comprise less than 10 percent of the U.S. population, but account for 35 percent of patients with acute coronary syndrome (ACS), which includes a recent heart attack or unstable chest pain. ACS is typically treated with anti-platelet therapies.

Earlier studies, for example, had shown that the platelet inhibitor prasugrel reduced the risk of adverse outcomes compared with clopidogrel in ACS patients undergoing coronary stent implantation. Those studies used a 60-mg initial dose followed by a 10-mg/day maintenance dose.

At that dosage level, however, patients older than age 75 had an increased risk of intracranial and fatal bleeding, as did younger patients weighing 132 pounds or less. The results led to warnings by the U.S. Food and Drug Administration and the European Medicines Agency for the use of the 10 mg/day maintenance dose of prasugrel in those populations, and consideration of a reduced dose (5 mg/day) to mitigate bleeding complications.

To examine whether older patients might benefit from a lower dosage of prasugrel, the Duke-led researchers analyzed more than 2,000 older patients who participated in a large trial called TRILOGY ACS that compared prasugrel with clopidogrel to manage acute coronary syndromes without coronary stent implantation or coronary bypass surgery.

The findings from this study, the first long-term data on outcomes specifically from elderly patients treated with the reduced dose of prasugrel, determined that a smaller dosage of 5-mg/day of prasugrel presented no greater risk of bleeding problems than the commonly prescribed 75-mg dose of clopidogrel in the elderly population.

"The findings from our study indicate how difficult it is to identify the right dose of anti-clotting medications for the elderly, to improve outcomes after a heart attack," said co-author Magnus Ohman, professor of medicine at Duke and chairman of the TRILOGY ACS study. "While a lower dose seemed intuitive, it was safe but not more effective. Future dedicated studies need to continue to find the right therapies for the vulnerable elderly patients."


'/>"/>

Contact: Sarah Avery
sarah.avery@duke.edu
919-660-1306
Duke University Medical Center
Source:Eurekalert

Related medicine news :

1. Metering Pump / Chemical Injection (Metering /Dosing) Pump Market to $4.1 Billion by 2017, With a CAGR of 5.3% From 2012 to 2017 – New Report by MarketsandMarkets
2. Study of tenofovir vaginal gel shows daily dosing ineffective due to lack of adherence
3. NIH-funded analysis estimates effective PrEP dosing
4. Prisons must do more to provide health and social care to growing population of older prisoners
5. Virtual adviser helps older Latino adults get more exercise, Stanford researcher says
6. Spectrum Surgical Offers Veterinary Gold-Handled Needle Holder Repair & Refurbishing Services
7. BMA Affordable Assisted Living Community Conducts Weekly Strength Training Classes for Older Adults
8. Single dose of ADHD drug can reduce fall risk in older adults -- Ben-Gurion U researchers
9. Elevate Ventures Partners with Southwest Indiana Region Community Stakeholders to Launch Regional Entrepreneurship Action Plan
10. Research finds racial/ethnic disparities in health care among older male cancer survivors
11. Tailoring diabetes treatment to older patients yields dramatic results
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/22/2017)... Tampa, Fla. (PRWEB) , ... February 22, 2017 ... ... the field of regenerative medicine in recent years. The technology is so cutting ... sanction regulations on the protocol for stem cell procedures. However, successful patient outcomes ...
(Date:2/22/2017)... ... 2017 , ... Giving patients with diabetes customized coaching sessions, ... hospital admissions, and better blood pressure and glycemic control, a new study ... be found here . , The study comes as health plans increasingly ...
(Date:2/22/2017)... ... February 22, 2017 , ... Sideline Products participated in the World Horse ... host Tom Seay and his production crew. Tom Seay’s program “Best of America ... world. Saddle Sidekicks will be featured on April 6, 2017. After the broadcast, ...
(Date:2/22/2017)... ... February 22, 2017 , ... The ... Insights to help small practices in Delaware, New Jersey, Pennsylvania and West Virginia ... Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). , This technical ...
(Date:2/22/2017)... ... February 22, 2017 , ... Forty-five percent of ... report that family members or friends have also commented about their poor hearing. ... wear hearing aids. One reason, suggested by 89 percent of American respondents, is ...
Breaking Medicine News(10 mins):
(Date:2/23/2017)... 2017 Orthopedic and cardiac devices will ... demographic patterns lead to an increasing prevalence of ... exercise-related injuries, chronic back problems, heart valve replacement, ... The future of medical implants faces many uncertainties. ... and more: - What types of medical ...
(Date:2/23/2017)... -- CTI BioPharma Corp. (CTI BioPharma) (NASDAQ and MTA: CTIC) ... quarter and full year 2016 financial results on Thursday, March ... markets. Following the announcement, members of the management team ... results and provide a general corporate update at 4:30 p.m. ... obtained as follows: Thursday, March 2 1:30 ...
(Date:2/22/2017)... VIEW, Calif. , Feb. 22, 2017 ... that it will release financial results for the fourth ... Wednesday, March 8, 2017.  The Company,s management team will ... PT / 5:00 p.m. ET. Investors interested ... by dialing (844) 707-0665 for domestic callers or (703) ...
Breaking Medicine Technology: