Healthcare Industry News: Venous Thromboembolism
News Release - December 12, 2006
New Study Shows Lovenox(R) (Enoxaparin Sodium Injection) Is More Effective Than Unfractionated Heparin (UFH) for Lowering the Risk of Venous Thromboembolism (VTE) in Patients With Acute Ischemic StrokeThe PREVAIL study showed that in acute ischemic stroke patients treated with Lovenox, the risk of having a VTE was lowered by a significant 43% with no statistically significant increase in clinically important bleedings when compared to UFH
ORLANDO, Fla., Dec. 12 (HSMN NewsFeed) -- Sanofi-aventis announced today that the results of the PREVAIL (Prevention of VTE after Acute Ischemic Stroke with LMWH Enoxaparin) study presented at the 48th American Society of Hematology (ASH) annual meeting in Orlando showed a significant 43% reduction in Venous Thromboembolism (VTE) events with enoxaparin vs. unfractionated heparin (UFH) in patients who suffered an acute ischemic stroke.
Among medically-ill patients, stroke patients are at an increased risk for developing VTE. Without VTE prophylaxis, up to 75% of patients with hemiplegia following stroke develop deep-vein thrombosis (DVT) and 20% develop pulmonary embolism (PE).
The significant 43% relative risk reduction in VTE events observed with enoxaparin vs. UFH for the primary efficacy endpoint (10.2 % vs. 18.1%; p= 0.0001) was associated with a consistent reduction in proximal DVT by 53% (4.5% vs. 9.6%; p=0.0003).
There was no significant difference in clinically important bleedings, corresponding to the combination of both symptomatic intracranial bleeding, the most serious complication, and major extracranial bleeding (1.3% vs. 0.7%, p = 0.20).
The reduction in VTE risk was also observed in patients presenting with different levels of stroke severity, with no significant difference in clinically important bleedings.
"Balancing the benefits of lowering the risk of VTE while minimizing the risk of bleeding is a very important element in choosing prophylactic regimens for this particularly fragile patient population, as it combines the usual factors of VTE in addition to the stroke context," said Dr. David Sherman, Professor in the Division of Neurology in the Department of Medicine at the University of Texas Health Science Center (UTHSC) in San Antonio, and principal investigator of the study. "PREVAIL showed that enoxaparin, when compared to UFH, had a superior efficacy with no significant increase in clinically important bleedings. These data provide new evidence that suggests enoxaparin can be used as VTE prophylaxis in this high risk population."
About Venous Thromboembolism (VTE)
Venous Thromboembolism is a general term used to describe the formation of a blood clot (thrombus) that blocks a vein. This may occur in any part of the venous system, but the most common manifestations are deep-vein thrombosis (DVT), usually in the leg, and pulmonary embolism (PE).
VTE is also a common complication among individuals who have experienced an acute ischemic stroke (AIS), a population of medically-ill patients at particularly high-risk for VTE.
PREVAIL trial is the first large-scale, multinational, prospective, randomized, open label study which enrolled 1,762 stroke patients (stratified by NIH Stroke Scale Score) in over 15 countries.
Patients confirmed with an acute ischemic stroke, were randomized within 48 hours of stroke symptoms to receive enoxaparin 40 mg SC or UFH 5000 IU SC Q 12 treatment for 10 days +/- 4 days with a follow up period of 90 days and stratified by NIH Stroke Scale Score (severe greater than or equal to 14 and less severe <14).
The primary efficacy endpoint was the composite of symptomatic or asymptomatic DVT, symptomatic or fatal PE during the treatment period. The primary safety endpoints included symptomatic intracranial bleeding, major extracranial bleeding and all-cause mortality.
Enoxaparin is an anticoagulant of the low molecular weight heparin (LMWH) class. Its clinical applications are linked to its antithrombotic properties. It is used to inhibit clot formation in venous or arterial vessels to avoid potential acute or chronic complications of venous or arterial thrombosis such as pulmonary embolism, myocardial infarction or death of cardiovascular origin. As with all anticoagulants, the most frequently reported side effect for enoxaparin is bleeding. Clinical indications for enoxaparin may vary from one country to another.
Important Safety Information
LOVENOX® (enoxaparin sodium injection) cannot be used interchangeably with other low-molecular-weight heparins or unfractionated heparin, as they differ in their manufacturing process, molecular weight distribution, anti-Xa and anti-IIa activities, units, and dosage.
When epidural/spinal anesthesia or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low-molecular-weight heparins or heparinoids are at risk of developing an epidural or spinal hematoma, which can result in long-term or permanent paralysis.
The risk of these events is increased by the use of postoperative indwelling epidural catheters or by the concomitant use of drugs affecting hemostasis. Patients should be frequently monitored for signs and symptoms of neurological impairment. (See boxed WARNING).
As with other anticoagulants, use with extreme caution in patients with conditions that increase the risk of hemorrhage. Dosage adjustment is recommended in patients with severe renal impairment. Unless otherwise indicated, agents that may affect hemostasis should be discontinued prior to LOVENOX® therapy. Bleeding can occur at any site during LOVENOX® therapy. An unexplained fall in hematocrit or blood pressure should lead to a search for a bleeding site. (See WARNINGS and PRECAUTIONS).
Thrombocytopenia can occur with LOVENOX®. In patients with a history of heparin-induced thrombocytopenia, LOVENOX® should be used with extreme caution. Thrombocytopenia of any degree should be monitored closely. If the platelet count falls below 100,000/mm3, LOVENOX® should be discontinued. Cases of heparin-induced thrombocytopenia have been observed in clinical practice. (See WARNINGS).
The use of LOVENOX® has not been adequately studied for thromboprophylaxis in pregnant women with mechanical prosthetic heart values. (See WARNINGS).
LOVENOX® is contraindicated in patients with hypersensitivity to enoxaparin sodium, heparin, or pork products, and in patients with active major bleeding.
Please see accompanying full prescribing information including boxed WARNING.
Please visit http://www.lovenox.com for complete prescribing information, including boxed WARNING, and additional important information.
Sanofi-aventis is the world's third largest pharmaceutical company, ranking number one in Europe. Backed by a world-class R&D organization, sanofi-aventis is developing leading positions in seven major therapeutic areas: cardiovascular, thrombosis, oncology, metabolic diseases, central nervous system, internal medicine, and vaccines.
Sanofi-aventis is listed in Paris (EURONEXT: SAN) and in New York (NYSE: SNY )
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