Stephan Moll, MD writes: A drug in development (Idarucizumab) that reverses the blood thinner Pradaxa® (Dabigatran) is on a very promising path to get FDA approval in the next few months and be available for clinical use by the end of 2015.
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Stephan Moll, MD writes… A publication today in the journal Vascular Medicine discusses - for patients and family members – (a) in which patient with blood clots (DVT, PE) to consider testing for a clotting disorder, (b) what tests might be appropriate to do, (c) how the test results influence management with blood thinners, (d) what birth control methods are safe in women with history of blood clots or a clotting disorder, and (e) in which family members to consider thrombophilia testing (link here for the article).
Last updated: April 1st, 2015
Stephan Moll, MD writes…. Today (Jan 8th, 2015) the FDA approved yet another new oral blood thinner, Savaysa (edoxaban), for the treatment of DVT and PE. The drug was also FDA approved today for stroke prevention in patients with irregular heart beat (atrial fibrillation). The FDA press release here (link). Read the rest of this entry »
Stephan Moll, MD writes (Dec 17, 2014)… The American Society of Hematology (ASH) published last week two things that physicians dealing with DVT, PE and blood thinners should avoid [ref 1]. Read the rest of this entry »
Stephan Moll, MD writes (on Dec 8th, 2014)… A publication this week in the New England Journal of Medicine reports on a drug in development that protects patients from blood clots (DVT), without increasing the risk of bleeding. Too good to be true? Possibly, but may be not. Additional studies will have to tell. Read the rest of this entry »
Stephan Moll, MD writes (on12/5/2014)… Prevention of DVT and PE in patients who are in the hospital is important. Hospitals are required to have mechanisms in place that guarantee that patients at risk for DVT and PE get appropriate prophylaxis [reference]. We have developed at the University of North Carolina (UNC) a guidance document (link here; UNC VTE prophylaxis guidance document) as a resource for our doctors to assist in making decisions on which patients to give what type of DVT and PE prophylaxis. We are making this document available for other doctors and hospitals, to use it as is or modify it as needed.
Recommendations provided in this document are a reflection of current guidelines, clinical evidence, and UNC institutional initiatives. Patients may look at this document to see what kind of DVT prophylaxis might be appropriate in certain situations, such as surgeries; and they should discuss appropriate prophylaxis with their physicians. However, this document is not intended to replace individual patient evaluation and management decisions.
Joint Commission VTE measures (link here)
Last updated: Dec 5th, 2014
Stephan Moll, MD writes (on Nov 7th, 2014)… A publication this week in the New England Journal of Medicine reports on a new reversal agent (PER977 = Aripazine = ciraparantag) that may be effective against a number of different new oral anticoagulants [ref 1]. Read the rest of this entry »
Stephan Moll, MD writes… For patients stopping blood thinning therapy (anticoagulation) whose deep vein thrombosis (DVT) or pulmonary embolism (PE) was considered unprovoked (i.e. out of the blue and with no obvious triggering, transient cause, such as surgery, hormone use, immobility), aspirin is beneficial in some patients in preventing further clots. A new publication in the journal Circulation re-confirms findings from two previous studies, showing that aspirin reduces the risk of recurrent DVT/PE by more than a third without significantly increasing the risk of bleeding [ref 1,2,3]. Read the rest of this entry »
Stephan Moll, MD writes… Apixaban (Eliquis®) was approved by the FDA this week (Aug 21, 2014) for the treatment of DVT and PE. The approval covers (a) acute DVT/PE management and (b) the longer-term prevention of recurrent DVT/PE. Read the rest of this entry »
Beth Waldron, Clot Connect program director writes…
Background: Blood thinners (anticoagulants such warfarin, Xarelto, Pradaxa, Eliquis, enoxaparin) and anti-platelet drugs (aspirin, Plavix) increase bleeding risk. Patients taking these drugs are typically advised to avoid activities which might cause increased bleeding, bruising or trauma.
Acupuncture involves the insertion of thin needles through the skin at strategic points along the body. These needles are very thin, much smaller than the hypodermic needles used for phlebotomy (blood draws) and injections.(Ref 1) Because the needles used are so small, very little bleeding occurs with acupuncture. (2)
- A 2014 published study on the safety of acupuncture for patients taking blood thinners found no reports of major bleeding.(3) Minor ‘microbleeding’—defined as bleeding which stopped within 30 seconds—occurred in only slightly more patients taking an anticoagulant (4.8%) than patients not on an anticoagulant (3.0%). Patients taking an anti-platelet medication had very little bleeding (0.9%).
- There was also no significant difference in the amount of bruising which occurred from acupuncture between those taking an anticoagulant (2.0%) or an anti-platelet (1.6%) and those who took neither (1.3%).
- An earlier study of acupuncture among hospitalized patients taking warfarin, also found very little bleeding and that a higher INR value did not predict a higher risk of bleeding–bleeding incidence after acupuncture were no different among patients with a low INR (14.6%) and those with a high INR (14.3%). (4)
Summary: Acupuncture appears to be safe for the patient on a blood thinner. However as a precaution, inform your acupuncture provider in advance of the procedure that you are on a blood thinner so they can be alert and prepared.
1. UpToDate http://www.uptodate.com/contents/acupuncture
2. “A Guide to Integrative Oncology” University of Washington http://depts.washington.edu/integonc/patients/spc/acupuncture.shtml
3. Kim et al. The safety of acupuncture treatments for patients taking warfarin or antiplatelet medications: A retrospective chart review study European Journal of Integrative Medicine, May 17, 2014. http://www.sciencedirect.com/science/article/pii/S1876382014000626
4. Miller et al. Acupuncture treatment for hospitalized patients on anticoagulant therapy—a safety study BMC Complementary and Alternative Medicine 2012 (Suppl 1) p 107