I can remember not too many years ago cardiac patients usually took aspirin as a preventative medication (anti platelet med) and if you were at a high risk for problems (and you could afford it) you took clopidogrel (Plavix). Both excellent and fairly safe drugs if used as recommended. Not long ago it became fashionable to give patients both drugs for added protection. Is that a good idea?

This week a study published in the Archives of Internal Medicine states that the risk of bleeding in these patients taking both medications is substantial and should be treated as such. Even though this approach is still safer than warfarin which is also prescribed for several cardiac problems, the risk needs to be recognized. 

In this study there were 7,764 emergency room visits among the dual treated patient group and most of those were for bleeding though usually minor. There were 40,924 warfarin treated patients for bleeding which were recorded for context. Once again most of this bleeding was also minor. The bleeding risk with warfarin is rarely ignored while the risk for dual anti platelet therapy is often down played or not recognized.

While the bleeding may not usually be serious in these patients on both aspirin and clopidogrel (Plavix), the risk is real and should be taken seriously by doctors and patients alike. The authors of the study also suggest that patients should be made aware of the risk of bleeding but stress that the risk is not a reason to abandon the therapy.

If you or a loved one is on both aspirin and clopidogrel (Plavix) you may want to discuss what you might expect with your prescriber. bjmdjd

Material modifications since posting: none

Archives of Internal Medicine · aspirin · Plavix · risk of bleeding · warfarin

A federal regulation was issued November 22nd which may require some health insurance companies to return part of their premiums to some of their insureds. At the end of this year the Health and Human Services (HHS) dept. will review the insurance companies medical loss data. Those companies that are spending less than 80% – 85% of their premium dollar on direct medical care will be required to issue refunds to consumers.

This medical loss ratio rule was developed by the National Association of Insurance Commissioners and submitted to the HHS in response to the Affordable Care Act. Also starting in 2011 insurance companies will have to make public how they spend their premium dollars.

I wouldn’t start spending those refund checks yet. The first ones will not be issued until sometime in 2012! They could be significant though. According to the HHS, insurers in some areas are spending as little as 60% of their premium dollars on direct care. bjmdjd

Material modifications since posting: none

Health and Human Services · health insurance premium dollars · HHS · medical loss ratio rule · National Assoc. of Insurance Commissioners

It appears that one of my favorite opioid pain medications will no longer be available in the United States. The Food and Drug Administration (FDA) has asked that propoxyphene (brand names Darvon and Darvocet) be withdrawn from the U.S. Market. All generic formulations will also be withdrawn.

Some new data that has come to light shows that patients using propoxyphene are at an increased risk of cardiac rhythm abnormalities that can be serious and even fatal. This is true even at the recommended doses. Withdrawal of the drug is already underway in Europe.

Long term users of the drug are not being asked to abruptly stop their medication but to call or visit their healthcare provider to discuss a change in their treatment plan. bjmdjd

Material modifications since posting: none

cardiac side effects · Darvocet · Darvon · FDA · Food and Drug Administration · propoxyphene

An advisory committee of the U.S. Centers for Disease Control and Prevention has recommended that the vaccine given to prevent meningitis be given as a booster to 11 and 12 year olds. The previous recommendation was to give it before a young person went to college to help prevent the disease in settings like dorm rooms where transmission rates are high. The new recommendation is because the protection offered by the dose given to an infant is no longer believed to last as long as it was once thought.

A recent article in the New England Journal of Medicine reports that the incidence of pneumococcal meningitis has decreased since the vaccine was introduced in 2000. It is expected that the CDC will accept the recommendation of the advisory committee. bjmdjd

Material modifications since posting: none

Centers for Disease Control and Prevention · meningitis · meningitis vaccine · pneumococcal meningitis

The results of two new meta analyses has revealed that the lower a person’s LDL (bad cholesterol) the better. There is benefit shown without risk all the way down to an LDL of 50 mg/dL. The results were published in the Lancet this week.

While the results were based on patients with a high risk of cardiovascular disease it is felt that they hold true for people at any elevated risk level. Instead of using simvastatin 80 mg to shoot for these low levels it is felt that high doses of the newer statins like Lipitor or Crestor or a combination of simvastatin 40 mg with pravastatin 40 mg is better to lower the risk of myopathy.

Data from 170,000 patients was analyzed. bjmdjd

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Crestor · Lancet · LDL · Lipitor · simvastatin

Now that’s certainly not a title I would have ever expected to write! But evidently it is a problem. I apologize for being a couple of days late writing about this but I have been tied up in a family health crisis and that had to come first.

For the third time this year the maker of the popular cholesterol lowering medication is recalling some of the product due to an unpleasant odor. This will make about 400,000 bottles of the drug that has been recalled. Supposedly the risk of serious illness is remote and the smell has been traced to a chemical used to treat the wooden pallets on which the bottles are stored and shipped in Puerto Rico. Some patients have reported some GI symptoms after using the affected product.

The company announced that there may be more recalls but if any patient encounters some of this moldy smelling Lipitor they can have it replaced at no charge at their pharmacy. bjmdjd

Material modifications since posting: none

Lipitor. Lipitor recall