Aspirin May Not Protect the Heart After Non-Cardiac Surgeries

Giving aspirin to patients around the time of surgery may do them more harm than good, a large new study finds.

Surgery of any kind — not just heart surgery — may raise a person’s risk for having a heart attack, research has shown. Doctors often start patients on a low dose of aspirin shortly before and after their procedures to help prevent those events.

But the new study, which pitted aspirin against a dummy pill (“placebo”) in over 10,000 patients who were having major surgeries that didn’t involve their hearts, found that not only did aspirin fail to prevent heart attacks, it also significantly increased the risk of major bleeding.

The authors pointed out that many patients were already taking other drugs meant to prevent blood clots.

The most common surgeries in the study were orthopedic procedures like joint replacements.

The study was presented Monday at the annual meeting of the American College of Cardiology in Washington, D.C., and jointly published online in the New England Journal of Medicine.

The finding stunned several experts.

“This is something that has been hotly debated for years,” said Dr. Kurt Pfeifer, an associate professor at the Medical College of Wisconsin, in Milwaukee. Pfeifer practices perioperative medicine, a specialty that focuses on getting patients safely through surgery.

“The paradigm had shifted a number of years ago to fairly routinely operating through aspirin with the idea that we were reducing the risk of cardiovascular events,” said Pfeifer, who wasn’t involved in the research. “That’s what’s troubling about this study,” he added.

“This is unexpected,” agreed Dr. Steve Cohn, medical director of the Uhealth Preoperative Assessment Center at the University of Miami Hospital. “We were thinking aspirin was potentially protective,” said Cohn, who was not involved in the research.

For the study, researchers recruited patients from 135 hospitals in 23 countries. Half were randomly assigned to take 200 milligrams of aspirin just before surgery and then to continue on 100 milligrams for up to a month after surgery. The other half took a placebo pill.

Half of the patients were already taking a low-dose aspirin every day when they entered the study. Those patients were told to stop their daily aspirin at least three days before surgery and pick it up again seven days after.

The average age of patients who participated in the study was 68, almost evenly divided between women and men. About a third of patients in both groups had a history of blood clots that had caused heart attacks, strokes, or peripheral vascular disease. And nearly two-thirds also got some kind of additional blood thinner, typically Lovenox or Xarelto, to prevent clots.

Nearly the same number of patients, about 7 percent, died or had a heart attack within 30 days of their surgeries, whether they took aspirin or the placebo — 351 of 4,998 patients in the aspirin group compared with 355 of 5,012 patients who took the placebo. That was true even for patients who were already on a daily aspirin regimen before their operations.

But significantly more patients in the aspirin group experienced major bleeding than those who took the placebo — 230 patients versus 188 in the placebo group.

The findings contradict previous studies that found that aspirin could help prevent heart attacks after surgery. But those studies were smaller, the researchers noted, or looked at surgical outcomes after treatments had already been assigned, making their results less definitive.

Researchers say it could be that aspirin does prevent heart attacks caused by blood clots, but when it’s given to patients in addition to other blood thinners, as is often the case, the bleeding risk cancels any benefit.

Bleeding can also cause heart attacks, explained study author Dr. P.J. Devereaux, an associate professor of epidemiology and biostatistics at McMaster University in Ontario, Canada. A sharp drop in blood pressure can seriously stress the heart, sending it into cardiac arrest.

“The perioperative period is a tricky period in terms of balancing these competing physical effects that are going on,” Devereaux said.

“We should stop aspirin during the perioperative period, because we’re only putting patients at risk without an apparent benefit,” he added.

“Perioperative period” refers to the time shortly before, during and shortly after surgery.

For patients who take a low dose of aspirin each day to prevent either first or second heart attacks, Devereaux said the study found that it’s safest to resume that regimen eight to 10 days after surgery, since that’s when bleeding risk subsides.

By : Brenda Goodman

Article Source : http://news.health.com/

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Taking Blood Thinners With Certain Painkillers May Raise Bleeding Risk

People taking blood thinners to prevent clots in their legs or lungs may put themselves at risk for serious internal bleeding if they also take common painkillers such as aspirin or ibuprofen, researchers warn.

These over-the-counter painkillers — called nonsteroidal anti-inflammatory drugs (NSAIDs) — include such drugs as Advil, Aleve, Bufferin, Excedrin, Motrin and Nuprin, as well as aspirin. Patients who use blood thinners such as warfarin, Eliquis, Xarelto or Pradaxa should not take them, the researchers said.

“If you are taking an NSAID while taking an anticoagulant, your risk of a major bleed is double what it would be if you weren’t taking an NSAID,” said lead researcher Dr. Bruce Davidson. He’s with the division of pulmonary and critical care medicine at the University of Washington School of Medicine in Seattle.

One-quarter of these major bleeds happen within eight days of taking an NSAID, Davidson said. “It’s not like you have to be taking them for weeks or months. Some bleeds happen with a single dose,” he said.

The risk of bleeding might be even greater for people with an irregular heartbeat, called atrial fibrillation, who take a blood thinner and use an NSAID, Davidson said.

“The message for people is if you’re taking a blood thinner, do not take an NSAID — just don’t take one,” Davidson said.

“If you have a headache or aching muscles or joints, take generic Tylenol [acetaminophen]. Don’t take NSAIDs for casual use,” he added.

The report, published online April 14 in JAMA Internal Medicine, said the bleeding is often minor but can be fatal in some cases.

It’s known that aspirin use by patients on anticoagulant therapy doubles the risk of bleeding, said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, and spokesman for the American Heart Association.

But whether NSAIDs such as Advil or Motrin are associated with increased risk of bleeding among patients receiving anticoagulant therapy wasn’t clear, Fonarow said. Some studies showed raised risk with drugs like Coumadin (warfarin), Eliquis (apixaban), Xarelto (rivaroxaban) or Pradaxa (dabigatran), while others didn’t.

Patients should consult their doctor before combining these medications, he advised.

“NSAID or aspirin therapy should be used only with caution and only if no similarly effective and safer alternative treatment is available. Use of Tylenol may be more advisable for people with headache or muscle aches while receiving anticoagulation therapy,” Fonarow said.

For the study, Davidson’s team analyzed data from the worldwide EINSTEIN deep vein thrombosis and pulmonary embolism studies, which included over 8,000 patients. The trials compared two blood thinners — Xarelto and warfarin — to see which was better at preventing blood clots in the legs and lungs.

Drugs that prevent clotting always carry the additional risk of internal bleeding, which can become serious and life-threatening, experts say.

Davidson’s group also looked at whether taking NSAIDs with these blood thinners might increase the risk for bleeding. They found it did.

He said that, according to the study, the absolute risk for a major bleeding episode for a patient taking aspirin and a blood thinner was nearly double that of a patient not on aspirin. For patients taking another form of NSAID plus a blood thinner, there was triple the risk compared to those taking the blood thinner alone, Davidson said.

However, the association found in the study does not prove a cause-and-effect link.

By : By Steven Reinberg

Article Source : http://news.health.com/2014/04/14/taking-blood-thinners-with-certain-painkillers-may-raise-bleeding-risk/

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Every Minute Matters With Clot-Busting Stroke Drug: Study

Every 15-minute delay in receiving a clot-busting drug means stroke survivors will have about one month less of a disability-free life, while every minute sooner that they receive the drug translates into more than one extra day of healthy life.

That’s the finding of a study that examined the use of tissue plasminogen activator (tPA) in treating ischemic strokes, which occur when a blood clot blocks blood flow to the brain.

Guidelines say the drug should be given within four and a half hours after stroke symptoms begin, but this study shows that the earlier patients receive the drug within that window, the better.

Researchers applied the findings from major clot-busting drug trials to more than 2,200 stroke survivors in Australia and Finland to determine what their outcomes would have been, depending on when they were given tPA.

For every minute earlier that they received the drug, patients gained an average of nearly two more days of healthy life. Faster treatment helped all patients, but younger ones seemed to get slightly more benefit than older ones, according to the study, which was published in the March 13 issue of the journal Stroke.

“‘Save a minute, save a day’ is the message from our study, which examined how even small reductions in treatment delays might benefit patients measurably in the long run,” study author Dr. Atte Meretoja, an associate professor of neurology at the University of Melbourne, in Australia, said in a journal news release.

People who develop stroke symptoms, such as arm weakness, speech problems or face droop, should call for help immediately, the researchers said.

“Clot-busting treatment works equally well, irrespective of race, ethnicity or gender,” Meretoja said. “Speedy restoration of blood flow to the brain is crucial for brain cell survival everywhere.”

Article Source : http://news.health.com/

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What Are Your Odds of a Heart Attack?

Each year heart attacks kill more than 150,000 Americans, nearly half of them women. If such a grim statistic can have a bright side, it's this: Most heart attacks today aren't fatal. 

About 75% of men and 60% of women live at least one year after an attack.

Who is most at risk?
While most heart attack victims are middle-aged or older—the average age for a first attack is 66 for men and 70 for women—people in their 20s and 30s suffer attacks too. 

The risk of a heart attack climbs for men after age 45 and for women after age 55. 

When do heart attacks strike? 
Heart attacks occur roughly every 35 seconds in the United States, and most occur in the morning, a time when the platelets in the blood are especially "sticky" and prone to form clots. 

At least one study, however, has found that morning isn't a prime time for heart attacks among people who regularly take aspirin, which helps keep platelets from sticking together.

Beating the odds
Survival odds for people who have had a heart attack keep getting better thanks to advances in diagnosis, medication, and lifesaving technology. 

It's worth noting that survival rates for heart attack patients are better on weekdays compared to weekends, because medical personnel are more likely to use invasive procedures (including angioplasty and bypass surgery) during the week. 

Nonetheless, cardiologists are optimistic about the rate of improvement in cardiac care. When Sharonne Hayes, MD, director of the Mayo Clinic's Women's Heart Clinic, started practicing in the mid-1980s, doctors couldn't do much for people having heart attacks. "Now we can stop a heart attack in its tracks," she says. "Patients have a much better chance at recovery."

Article Source : http://www.health.com/

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Skipping Doses Can Be Dangerous for Heart Patients

The American Heart Association recently announced the biggest threat to heart patients—and it's not cheese fries or stress. It is "patients' failure to take prescription medicines correctly."

Statistics suggest that if a doctor prescribes a drug to 100 patients, 12% of them won't fill the prescription, another 12% will fill it but not take a single pill, and 22% will stop taking the drug before the prescription runs out.

Skipped meds, needless heart attacks

When it comes to medications for the heart, skipping doses can be costly. It's estimated that thousands of Americans have avoidable heart attacks each year because they neglect to consistently take the cholesterol-lowering statins prescribed by their doctors. A 2007 study of heart patients suggested that skimping on prescribed medications can double the risk of heart attack, stroke, or other cardiovascular events. 

Chris Spelius, 56, of Sun Valley, Utah, is one of those whose stubbornness could have turned him into a statistic. Although his cholesterol was soaring into the 400 range, the former Olympic kayaker was convinced that a vegetarian diet and an active lifestyle would bring it into a safe range. "I've never taken drugs, legal or illegal, and I didn't want to start now," he says. 

Finally, his doctor, Eliot Brinton, MD, a preventive cardiologist at the University of Utah School of Medicine, talked him into it. "My job is to badger the patient on a continual basis," he says. "You can have the world's most fit athlete, and they can have high cholesterol, and you can have a couch potato who has low cholesterol." Spelius was obviously in the former category. 

Article Source : http://www.health.com/

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Heart Healthy Foods: Shopping list

When it comes to your heart, what you eat matters. Follow these tips for heart-healthy eating:

1. Eat less saturated and trans fat. Stay away from fatty meats, fried foods, cakes, and cookies.
2. Cut down on sodium (salt). Look for the low-sodium or “no salt added” types of canned soups, vegetables, snack foods, and lunch meats.
3. Get more fiber. Fiber is in vegetables, fruits, and whole grains.

Take this list with you the next time you go food shopping.

Vegetables and Fruits

Eat a variety of vegetables and fruits. To save money, buy vegetables and fruits that are in season, frozen, or canned.

• Fresh vegetables such as tomatoes, cabbage, broccoli, and spinach
• Leafy greens for salads
• Canned vegetables low in sodium (salt)
• Frozen vegetables without added butter or sauces
• Fresh fruits such as apples, oranges, bananas, pears, and peaches
• Canned fruit in 100% juice, not syrup
• Frozen or dried fruit (unsweetened)

Milk and Milk Products

Look for fat-free or low-fat milk products. Or choose soy products with added calcium.

• Fat-free or low-fat (1%) milk
• Fat-free or low-fat yogurt
• Cheese (3 grams of fat or less per serving)
• Soy-based drinks with added calcium (soymilk)

Breads, Cereals, and Grains

For products with more than one ingredient, make sure whole wheat or another whole grain is listed first.

• 100% whole-wheat bread
• Whole-grain breakfast cereals like oatmeal
• Whole grains such as brown or wild rice, barley, and bulgur
• Whole-wheat or whole-grain pasta

Meat, Beans, Eggs, and Nuts

Choose lean cuts of meat and other foods with protein.

• Seafood, including fish and shellfish
• Chicken and turkey breast without skin
• Pork: leg, shoulder, tenderloin
• Beef: round, sirloin, tenderloin, extra lean ground beef
• Beans, lentils, and peas
• Eggs and egg substitutes
• Nuts and seeds

Fats and Oils

Cut back on saturated fat and look for products with no trans fats.

• Margarine and spreads (soft, tub, or liquid) with no trans fats
• Vegetable oil (canola, olive, peanut, or sesame)
• Non-stick cooking spray
• Light or fat-free salad dressing and mayonnaise

Article Source : http://healthfinder.gov/

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What to Expect During Your Heart Surgery Recovery

When preparing for surgery, it is wise to know what to expect from cardiac hospitals. Many people are mostly nervous about the surgery and preparation for it. Care should be taken beforehand to make blood donations for emergencies, provide an accurate list of all medications, and have a good understanding of what will happen during the procedure. While the surgery itself can last a few hours, much of the time is spent during recovery. Knowing what to expect is important so the patient and family can prepare themselves and their home, and the patient can make the best recovery possible. Everyone involved will receive instruction about what to do and to avoid for the six to eight weeks it could take to recover.

Manage pain

Pain is to be expected after surgery. The body has undergone trauma and will react to the incision site. The staff at cardiac hospitals will provide necessary prescriptions and instruction on ways to deal with it. Pain can manifest in the muscle all over the body or in the soft tissues around the incision site. There can also be numbness or itching involved. If the pain becomes too much to bear, then a doctor should be asked for recommendations to help provide relief, until the tissue can heal. However, keep in mind that many pain medications have sever side effects if abused beyond the prescription guidelines. It is important to follow the instruction of the doctor.

Promote healing

Some medical professionals recommend eating a healthy diet to aid in recovery. Cardiac hospitals can provide a list of meal planning options. If the appetite is suppressed, try feeding the patient smaller meals more often, but keep encouraging them to eat well. Common sense dictates that doing physical therapy to increase muscle tone can help the body heal and reduce pain more quickly. It is also important to not lift too much or over stress the incision site soon after the procedure. Sleep can also help the body heal. It might be difficult for the patient to get comfortable, but added pillows, soft music, maintaining a sleep schedule, and avoiding stimulants can all help them relax enough to rest.

Avoid infection

The most successful surgeries are those that avoid infection. The surgeons at cardiac hospitals will follow the strictest guidelines to keep a sterile environment for the surgery. However, when the patient returns home, there are innumerable ways the incision can be compromised. It is important to be gentile with the incision site and keep it clean and dry. The doctors and nurses can instruct on proper wound care methods. Contact the medical team immediately if any symptoms of infection appear, such as a raised temperature, gaping, drainage, redness, or warmth around the incision area.

Stay positive

Major surgeries often bring depressed feelings for both the patient and the caregiver. Worrying about the future, frustration with a slow healing process, and feeling pain are big contributors. It is important to beat the blues by maintaining daily activities, like getting dressed, going for walks, and participating in hobbies. One of the best ways for everyone to stay positive is simply to sharing feelings with each other. By utilizing the support network of friends and family, fears can be eased through the compassion and positive success stories.

Remember to check with your doctor before taking any medical remedy or treatment.



Article Source: http://EzineArticles.com/8782919

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