AHA Day 2-Atlas ACS TIMI

 We are now at TIMI something to the 6th power ( I exaggerate of course), but we are grateful for every one of those studies, including this one, with no CURRENT practical application, but lots of hope for the future, and no less important in our quest to lower inhospital and long term mortality with a pharmaceutical cocktail.  Dr. Michael Gibson gave an excellent but very basic and rudimentary explanation of the goals of this new compound "Rivaroxaban", a potent and selective Xa inhibitor.  "It treats the fluid part of the blood stream by inhibiting thrombin formation" he said. 

This  is merely a phase II study whose purpose is to pin down exactly which dose is both safe and most efficacious.   Though we are left to merely trust the investigators that this drug will have an indication some day, we are left wondering just how many of these medications our patients can afford and would be  willing to take. 

 The commentator gave an excellent review of definitions of bleeding, comparing and contrasting TIMI bleeding vs. other bleeding definitions, a point well taken and should be the first consideration in any study in which blood loss is an issue. We absolutely must understand these differnces in order to fully appreciate outcomes .  For instance,  the TIMI group's    5- gram Hb drop requirement before "bleeding" can be declared  leaves patients as  anemic as a vampire victim in an Anne Rice novel. (Sorry, I couldn't resist. We are in NOLA after all). Where as other definitions acknowledge bleeding if the Hb falls 2 gms or if the HCT falls 6%.   A  point well taken from the commentary on this drug is that we really REALLY  need to standardize our defintion of bleeding so we can discuss it more intelligently.   

The final commentary on this compound  was that "it yields irrefutable trends in reduction in CV events, but it does come at a cost of risk of increased bleeding" according to Dr.Hylek, here -to- fore undefined until the ideal dose is studied in a later Phase III trial.

Thanks Dr. Gibson for your diligent efforts in this area. 

We'll be waiting.  

Melissa

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