New type of blood thinner significantly reduces bleeding risk in trial

By Nancy Lapid

Patients with a common heart rhythm disorder who took an experimental blood-thinning drug had far fewer bleeding episodes than patients receiving a standard-of-care blood thinner, a new study has found.

A mid-stage trial testing abelacimab from Anthos Therapeutics in patients with atrial fibrillation was stopped early due to an overwhelming reduction in bleeding compared to the rate seen in patients taking Johnson Johnson’s Xarelto, or rivaroxaban, researchers reported on Wednesday in The New England Journal of Medicine.

Atrial fibrillation significantly raises stroke risks because it can increase the likelihood that blood clots will form in the heart that can travel to the brain. Many patients refuse or discontinue anticoagulants, however, because the drugs increase the risk of bleeding complications.

In the trial, 1,287 patients received either monthly injections of 150 milligrams abelacimab, 90 mg abelacimab, or a standard daily oral dose of rivaroxaban.

Abelacimab belongs to a new class of anticoagulants known as Factor XI inhibitors that work by blocking a protein in blood that plays a critical role in development of obstructive blood clotting but is less involved in hemostasis, which is the body's ability to prevent or control bleeding.

Over a median follow-up of roughly two years, the higher dose of abelacimab reduced bleeding requiring hospitalization or medical attention by 62 per cent compared with rivaroxaban, while the lower dose reduced those types of bleeding by 69 per cent, the researchers reported.

Gastrointestinal bleeding – the most common complication with blood thinners – was reduced by 93 per cent with abelacimab 150mg compared with the JJ drug. Xarelto is a Factor Xa inhibitor similar to Eliquis from Bristol Myers Squibb and Pfizer .

Earlier data from the same trial showed low rates of bleeding during surgical procedures in patients fully anticoagulated with abelacimab.

The trial was not designed to test the drug's effectiveness at preventing strokes, however.

Abelacimab has received Fast Track designation from the U.S. Food and Drug Administration for preventing clots associated with atrial fibrillation and with cancer, the manufacturer has said.

Other Factor XI drugs in development include MK-2060, being tested by Merck Co for reduction of major thrombotic cardiovascular events in patients with end-stage renal disease.

Bacteria may help prevent weight gain

Treatment with “good” bacteria may help people keep their weight in check, experiments in mice suggest.

Animals injected weekly with Mycobacterium vaccae, a microorganism found in cow’s milk and soil, were essentially immune to weight gain from a high-fat, high-sugar junk-food diet, researchers reported in Brain, Behavior and Immunity.

“We saw a complete prevention of diet-related weight gain in these animals,” study leader Christopher Lowry of the University of Colorado Boulder said in a statement.

“This suggests that exposure to beneficial bacteria can protect us against some of the negative health outcomes of the typical Western diet.”

The researchers had previously found that M. vaccae can prevent stress-induced inflammation and associated health problems in mice.

When they subsequently attempted to learn whether the bacteria could also help counter some of the brain inflammation and anxiety that can result from a poor diet, they found not only that it could, but that the organisms also prevented weight gain.

The mice received either healthy food, junk food, or junk food with weekly injections of M. vaccae. All groups received about the same number of calories.

As expected, the untreated junk food group gained significantly more weight than the healthy eaters. But to the researchers’ surprise, there was no difference in weight gain between the junk food group that got injections of good bacteria and the healthy eaters.

More research is needed to determine just how exposure to a bacteria found in dirt could prevent weight gain, and whether it can do so in people.

Add “prehab” to rehab for speedier surgery recovery

Recovery from surgery can be improved not just with rehabilitation programs afterward but also with “prehabilitation” beforehand, a review of clinical trial results suggests.

Adults who actively prepared for major surgery by exercising and improving their diet had fewer complications and shorter hospital stays, according to researchers who analyzed data from 186 randomized, controlled studies involving a total of 15,684 participants.

After taking into account the type of surgery and patients’ individual risk factors, they found the risk of complications was reduced by 50% with pre-surgery exercise, 38% with pre-surgery nutritional support, and 36% with a combination of exercise, nutritional, and psychosocial support, according to a report published on Wednesday in The BMJ.

Compared with usual care, combined exercise and psychosocial support was associated with 2.44 fewer days in hospital. Individually and in combination, exercise and nutrition were associated with roughly one less day in the hospital.

The researchers noted that the dependability of their results is “generally low to very low” because of differences in the ways the trials were conducted.

Still, they say, the results “were robust after excluding trials with a high risk of bias, suggesting that prehabilitation based on exercise, nutrition, or exercise combined with other components, may benefit adults preparing for surgery.”