Ok, here's evidence of a benefit, at least, of genetic testing for warfarin.

The study was conducted by Medco, and presented at the ACC cardiology meeting this week.

As if there aren't enough people taking Plavix already ($6 billion in sales per year) researchers published a study today showing incremental benefit to adding plavix to aspirin in atrial fib patients deemed not candidates for coumadin. The issue is this: coumadin has long been shown to be superior to aspirin for preventing stroke in atrial fibrillation. Coumadin's bleeding risk is similar to asprin but only if properly managed in a compliant patient.

Unexpected development: a small study reports good efficacy of a cage-like device implanted in the hearts of patients with atrial fibrillation. Right now we give people a medicine coumadin to prevent strokes from atrial fibrillation (a common heart arrhythmia). A company has introduced a device that evidently accomplishes the same goal. Complications were up around 7% which is more toxic than coumadin which has about a 1% per year serious bleed risk (about the same as aspirin). The Reuter's article calls coumadin "notoriously difficult to manage " as if it were some sort of villain.

Yesterday the FDA posted a note expressing concern about the bleeding risk of rivaroxaban a new type of blood thinner expected to eventually supplant coumadin. Millions of Americans take coumadin for stroke prevention and prevention and treatment of blood clots. http://money.cnn.com/news/newsfeeds/articles/djf500/200903171127DOWJONES... The problem with coumadin is that it has to be monitored at least monthly. It has a narrow "therapeutic index " which means it can cause bleeding if the level gets too high and repeat blood clots if the level gets too low.

Annals of Internal Medicine takes the whole aspirin for cardiovascular disease question and runs with it. Results published there this week show that the dose of aspirin doesn't seem to matter in a large population cohort over 10 000 patients. Common sense would dictate that lower doses are safer. http://www.annals.org/cgi/content/short/150/6/I-22?rss=1 By the way bleeding rates peak at 3.6% in men with aspirin which is about what you find with coumadin so as time goes by I am becoming less fussy about the safety of coumadin (as long as it's properly managed coumadin).

Did the world really need another clinical trial looking at vitamin K reversal of coumadin? Well it's got one in no less a journal than Annals of Internal Medicine. I thought this question must have been answered by now by a handful of studies: if your patient has an excessive INR from coumadin you can quickly correct the number with vitamin K. The problem as the new article reports is that bleeding is not necessarily improved with correction of the INR. Wow.

Eltrombopag is a targeted platelet growth factor recently approved by the FDA for the treatment of patients with low platelets of unknown etiology. It is a thrombopoietin receptor agonist that has been revealed in pre-clinical research and early phase clinical trials to inspire the propagation and differentiation of platelet precursor stem cells in the bone marrow.

According to investigators who recently presented their findings in Dublin Ireland poor oral hygiene unhealthy teeth bleeding gums are linked with the higher incidence of heart disease(s). Their study and conclusions involved a departure from previously published reports that found that bacterial by-products and inflammatory mediators play a nig role in this association. Their report claims that the bleeding gums provide an portal of entry to the bloodstream thus increasing the incidence of heart attack.