Health Rounds: Lilly blood thinner tops AstraZeneca's for heart procedure patients with diabetes

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By Nancy Lapid

Nov 13 (Reuters) - Hello Health Rounds readers! Today we feature a trial showing that when patients with diabetes undergo artery-clearing procedures, not all blood clot-preventing drugs are alike. We also report on an anesthesia study that should provide some reassurance for women who give birth via C-section.

Blood thinners not equally effective for diabetes patients after heart procedure

Blood-thinning drugs that doctors often prescribe interchangeably after procedures to reopen narrowed heart arteries don’t work equally well in patients with diabetes, a study from India found.

All 1,800 study participants had Type 1 or Type 2 diabetes, and all had undergone minimally invasive interventions to clear a clogged coronary artery and prop it open using a drug-coated stent to help reduce the risk of reclogging.

Afterward, they received aspirin plus either AstraZeneca’s (AZN.L) Brilinta (ticagrelor) or Effient (prasugrel), sold by Eli Lilly (LLY.N) and Daiichi Sankyo (4568.T) , from a class of drugs known as P2Y12 inhibitors that are prescribed to prevent the formation of 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 recent American Heart Association Scientific Sessions in New Orleans.

Patterns were similar when rates of non-fatal heart attack, major bleeding, and death were analyzed separately.

“For individuals with Type 1 or Type 2 diabetes and complex coronary disease, there may be an advantage to treatment with prasugrel over ticagrelor,” study leader Dr. Sripal Bangalore of the NYU Grossman School of Medicine said in a statement.

“We were surprised by the results because we hypothesized that ticagrelor should be as good or perhaps even better than prasugrel,” he said. “It’s important to choose the right medicine, and at least from our data, we cannot say that ticagrelor and prasugrel are interchangeable.”

General anesthesia appears safe for C-sections

General anesthesia is a reasonable option for women giving birth via cesarean section, especially when spinal or epidural nerve blocks are ineffective, a new analysis shows.

Up to one in six women who receive regional anesthesia during a cesarean section may feel pain, and for some, the pain can be excruciating, but general anesthesia has long been avoided due to concerns about its effects on the baby, 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 infants born via cesarean section. Roughly half of the surgeries were done with general anesthesia.

While 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 not likely to be clinically meaningful, the researchers found.

They also found that babies born under general anesthesia were slightly more likely to need breathing support immediately after birth, but there was no increase in neonatal ICU admissions.

The research does not suggest that general anesthesia should replace localized techniques, but it can be a reasonable option in certain cases, the authors said.

“Since regional anesthesia is so widely used, it’s common for patients to feel that a spinal or epidural block is the only safe option for cesarean section,” study leader Dr. Mark Neuman of the Perelman School of Medicine at the University of Pennsylvania said in a statement. “But as our study shows, anesthesia type during pregnancy does not need to be one-size-fits-all.”