Monday, 29 August 2011


The annual meeting of the European Society of Cardiology is taking place at the moment in Paris. It is now the largest of the three big cardiology meetings - even bigger than the American Heart Association shindig.
Sharing of the proceedings of these meetings is now achieved via social networks - Twitter being the favourite. These meetings have also become associated with the carefully choreographed release of big trial results. The results are often intentionally released on the same day as the paper is published by a major medical journal - the New England Journal of Medicine probably being the commonest. The biggest of the trial results released at this particular meet has been those from the ARISTOTLE study.
In recent years, many of the big Pharmaceutical companies have brought new anticoagulant drugs onto the market. They all have their eye on the millions of patients around the world who are taking warfarin. Warfarin has been around for many years.  The evidence for its efficacy in decreasing mortality and morbidity in patients with DVT and atrial fibrillation (both very common conditions) has been known for years.  It is only in the past 1-5 years in the new era of evidence based medicine and protocols, that big efforts are being made to ensure patients do receive the right medicine. It is for this reason that warfarin use is increasing. The problem with Warfarin is that the dose prescribed is not (as with most other drugs) fixed. The dose depends on the results of a blood clotting test known as the INR (International Normalized Ratio).  A whole infrastructure of clinics and staff are required to administer this testing. This infrastructure is not present in less developed countries. It is also expensive.
One can see therefore why anticoagulant drugs are such an attractive target for big Pharma. Apixaban is the latest of these drugs to be studied. The ARISTOTLE study is a randomized controlled trial comparing this new drug to warfarin in the management of patients with permanent atrial fibrillation. Anticoagulant are required in these patients to prevent stroke. What this study has shown is that the new drug was associated with improved effects i.e. fewer strokes AND fewer side effects (episodes of bleeding - an inevitable side effect of anticoagulant drugs). These 'having your cake and eating it' results are stunning and the whole cardiology world has gone Twitter crazy.  Wish I'd had Bristol Myers  stock!
Anyway, here is the paper in full. I wonder how long NICE will take to approve it ?