Thursday, April 07, 2011


Some trial results from New Orleans, as the 60th ACC draws to a close.

1. MAGELLAN : This was a trial mainly for the West, where DVT and Pulmonary embolism following prolong recumbency is an issue. Dr Alexander Cohen and group from King's College, UK, studied 8101 patients with serious medical condition requiring prolonged bed rest, like CCF, severe respiratory insufficiency, serious infectious disease, stroke, etc. He gave half of them Rivaroxaban 10 mg daily for 35 days, and half of them subcut Enoxaparin ( lovenox ) 40 mg for 10 days ( standard therapy now ), to see if there is any benefit, in terms of DVT and acute pulmonary embolism. They found non. Rivaroxaban is a new Factor 10a inhibitor, that can be taken orally. From the findings of this study, looks like rivaroxaban is just as good as Enoxaparin ( Low molecular weight heparin ), in reducing DVT and APEs in patients at risk of DVT and APE. In the subgroup analysis however, there were more bleeding complications in the rivaroxaban group. In a way, we are trading ease of primary prophylaxis of DVT, with an increase incidence of bleeding.

2. The other paper presented on 5th April at ACC was OSCAR, a study in high risk elderly hypertensives, with one or more CVS risk factors, comparing high dose ARBs against an ARB / CCB combination. The study involved 1164 patients with a mean age of 74 years, and at least one other cardiovascular risk factor. The primary endpoint here was MACCE at 36months. This study was led by Dr Hisao Ogawa of Kumamokam U, Japan. Interestingly, they found that high dose olmesartan controlled BP as well as Norvasc / olmesartan combination. However when they did some sub-group analysis, they found that although BP control was good in both arms, there were less CV events in the group with pre-existing CV risk factors, treated by the CCB / ARB combination. The reverse was also true, that in those with pre-existing diabetes, the high dose ARB seemed to reduce the incidence of renal function deterioration.. The authors then suggested that high dose ARBs was just as good as CCB / ARB combination and which therapy we choose depends on the hypertensive subset, depending on their pre-existing CV risk factors. Apparently ARBs are very popular in Japan because ACE-I has a high incidence of cough, and so is not often used.

And now, a word from the sponsors : The "Weekend Seminar in Cardiology for GPs 2011" is on this weekend at Sime Darby convention Center. We have registered 900 attendees so far. Please do come and join the annual GP Cardiology carnival.


HaNaNi PaNiNi said...

Dear Dr,

I am a medical student and i would like to seek for your opinion regarding the matter.

i have been attached to a GP clinic whereby the doctor prescribed combination drugs of CCB and ACEi (Coveram) in hypertensive patients.

i thought that monotherapy should first be initiated. When asked on her views on the matter, she mentioned that rather than letting the BP to later climb up, might as well we start combination drugs early.

your views on this is greatly appreciated. thanks!

hmatter said...

Hi HaNaNi,
I must say that your approach was what was recommended in the 80s. But we now know that the majority of patients with HBP need two-three drugs for control. so the recommendation nowadays is to start with two medications, often in the form of combo pills to improve compliance.
I usually start with one drug, then add a second, and if the BP is controlled and stable, with adverse effects, then use the pills in combo forms.

HaNaNi PaNiNi said...

okay. that makes sense. thanks Dr