Platelet E-News: April 27th, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.

Contents:

ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine

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ITP and Platelet Disorders Research and Treatments

SURVEY SAYS: ITP TREATMENTS MAY CAUSE DISTRESS

Corticosteroids (ex. prednisone) caused the most distress of the five ITP treatments listed in an on-line survey taken by 589 people from PDSA. Nearly 38% of those surveyed who took corticosteroids reduced the dose or stopped the therapy due to side effects. More than half of the corticosteroid users reported at least one highly bothersome side effect, a larger percentage than splenectomy, IVIg, anti-D (ex. WinRho®), and rituximab (ex. Rituxan®), the other treatments queried. This is the first survey to link ITP treatments, resultant distress, and the impact on reducing or stopping ITP medications.

You can view the results of the entire survey at http://www.biomedcentral.com/content/pdf/1471-2326-12-2.pdf

Brown TM, et al. "Patient-reported treatment burden of chronic immune thrombocytopenia therapies." BMC Blood Disord. 2012 Mar 22;12(1):2. http://www.ncbi.nlm.nih.gov/pubmed/22436142

JAPANESE REQUIRE LOWER DOSE OF ELTROMBOPAG

A starting dose of 12.5 mg of eltrombopag (Promacta®/Revolade®), with a maximum dose of 50 mg, was given to 23 Japanese ITP patients instead of the 50 mg starting dose and 75 mg maximum dose approved in the US and Europe. There had been reports that people of East Asian descent responded differently to eltrombopag and this study set out to confirm whether this was true. In the study, 60% of the Japanese patients given the reduced dose responded to the treatment and none responded to the placebo. Twenty-two percent responded to the lowest dose of 12.5 mg, confirming that lower doses of eltrombopag are appropriate in this population.

Tomiyama Y, et al. "A lower starting dose of eltrombopag is efficacious in japanese patients with previously treated chronic immune thrombocytopenia (ITP)." J Thromb Haemost. 2012 Mar 12.
http://www.ncbi.nlm.nih.gov/pubmed/22409309

For more information about eltrombopag and other treatments that prompt the bone marrow to make more platelets see:
http://www.pdsa.org/treatments/conventional/platelet-growth-factors.html

TRANEXAMIC-ACID CAN STOP BLEEDING

Tranexamic-acid, an inexpensive compound that stops blood clots from breaking down, is being increasingly used to stop traumatic bleeding on the battlefield, in ambulances, and in emergency rooms. A ground-breaking 2010 clinical trial of trauma patients in 40 countries, Crash-2 (http://crash2.lshtm.ac.uk/), showed that it saved lives by stopping bleeding. But some countries, notably the US, have been slow to adopt its usage. One recent study of the drug showed it was effective in those with intracranial hemorrhage due to traumatic brain injury and another study estimates that it could save 128,000 lives worldwide, 4,000 in the US.

Note: In his talk "Treatment Options That Can Reduce the Risk of Bleeding in ITP Patients" at the 2011 ITP Conference, Dr. Craig Kessler mentioned the possibility of using tranexamic-acid, along with many other options, to stop bleeding for those with ITP. His presentation is summarized in the Summer 2011 issue of The Platelet News.
http://www.pdsa.org/products-a-publications/newsletters.html

McNeil, Jr. DG. "A Cheap Drug Is Found to Save Bleeding Victims." New York Times. March 21, 2012.
http://www.nytimes.com/2012/03/21/health/tranexamic-acid-cheap-drug-is-found-to-staunch-bleeding.html

Perel P, et al. "CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) intracranial bleeding study: the effect of tranexamic acid in traumatic brain injury, a nested randomised, placebo-controlled trial." Health Technol Assess. 2012 Mar;16(13):1-54.
http://www.ncbi.nlm.nih.gov/pubmed/22417901

Ker K, et al. "Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial." BMC Emerg Med. 2012 Mar 1;12:3.
http://www.ncbi.nlm.nih.gov/pubmed/22380715

MORE LEARNED ABOUT ITP IN CHILDREN

In a five-year follow-up of 96 children from Norway, Finland, and Sweden who had ITP lasting more than six months, researchers found that 50% recovered from their ITP. Fewer than half required hospitalization during the 5 years and only about 10% had a serious bleeding episode. Younger children with sudden onset of the disease recovered earlier and had fewer difficulties. The researchers conclude: "Aggressive management can be restricted to the minority of children with continuing severe thrombocytopenia and frequent, clinically significant bleeding events."

Rosthøj S, et al. "Duration and morbidity of chronic immune thrombocytopenic purpura in children: Five-year follow-up of a Nordic cohort." Acta Paediatr. 2012 Mar 16.
http://www.ncbi.nlm.nih.gov/pubmed/22429281

 

Hospitals, Insurance, and Medical Care

PHYSICIAN GROUPS RECOMMEND FEWER ROUTINE TESTS

Nine specialty societies representing 374,000 physicians each developed a list of five things that physicians and patients should question. Other specialty groups are also creating lists, all this in an effort to reduce unnecessary tests that significantly add to treatment costs and may even harm patients. Unnecessary treatments could account for one-third of the healthcare costs in the US. Policy changes, including the way insurance companies pay, are also helping to shift medical practice by reducing the incentive for physicians to order expensive tests. For a list of questionable practices see:
http://choosingwisely.org/?page_id=13

Rabin RC. "Doctor Panels Recommend Fewer Tests for Patients" New York Times. April 4, 2012.
http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html

EMPLOYER HEALTH COVERAGE CONTINUES TO DECLINE

The loss of employment between 2007 and 2010 was the main reason that the percent of children and working-aged adults covered by employer-based health insurance dropped from 63.6% to 53.5%, according to a new study. The percent of people covered is much lower for those close to the poverty level, in their early twenties, or with less education. However, well before 2007 the percent of those with employer-based health coverage was declining, most likely due to rising insurance costs. Findings of this study for the National Institute for Health Care Reform, a nonpartisan, nonprofit organization, are summarized in the research brief, "The Great Recession Accelerated Long-Term Decline of Employer Health Coverage," online at:
www.nihcr.org/Employer_Coverage.html

"Job Loss Biggest Driver of 10-Percentage-Point Drop in Employer Coverage from 2007-2010; Apart from Job Loss, Fewer Firms Offering and Workers Taking Up Coverage—Rising Costs Likely Cause." Health Systems Change News Release. March 15, 2012
http://www.hschange.com/CONTENT/1281/

 

General Health and Medicine

LIFESTYLE AND CARDIOVASCULAR RISK…ARE YOU IN THE 2%?

The American Heart Association lists seven lifestyle factors associated with reduced cardiovascular disease: not smoking; being physically active; having normal blood pressure, blood glucose, total cholesterol levels, and weight; and eating a healthy diet. Of the 44,959 adults tracked from various databases in a new study, fewer than 2% had the seven positive indicators. About one in three Americas die of cardiovascular-related diseases, making it the leading cause of death.

Note: Low platelets do not protect people with ITP from developing blood clots or other cardiovascular diseases. In fact, the platelets of people with ITP are more reactive and may form blood clots more easily than those without the disease.

Yang Q, et al. "Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults." JAMA. 2012 Mar 28;307(12):1273-83.
http://www.ncbi.nlm.nih.gov/pubmed/22427615

SLEEP WELL, REDUCE INFLAMMATION

When the IL-6 level (a marker for inflammation) of older adults was measured after they were given a stressful mental test, the level of those who slept poorly was up to four times greater than the IL-6 of those who slept well. Poor sleepers also reported more stress, more loneliness, and more depression. Researchers eliminated other possibilities and determined that poor sleep alone was the cause of the increased inflammation in this study of 83 adults with an average age of 61. The level of IL-6 found in the poor sleepers was consistent with an increased risk of illness and death in this population.

Note: ITP is often associated with systemic inflammation. An increased level of IL-6 in ITP patients has been linked to fatigue.

Heffner KL, et al. "Sleep Disturbance and Older Adults' Inflammatory Responses to Acute Stress." Am J Geriatr Psychiatry. 2012 Feb 10.
http://www.ncbi.nlm.nih.gov/pubmed/22327621

 

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This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web: http://www.pdsa.org, e-mail: pdsa@pdsa.org

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