CLINICAL NEWS
Written in Blood
Continued from page 18
Advertising and Marketing
The United States and New
Zealand are the only countries
that allow prescription drugs to
be advertised to consumers on
television, and the amount of
money invested into pharmaceutical marketing each year
is “staggering,” Mr. Jones and
colleagues wrote. Nine of 10
large pharmaceutical companies
spend more money annually
on marketing than they do on
research and development and,
in 2012, nearly $3.5 billion was
invested in the United States in
pharmaceutical marketing.
“Patients, physicians, and
health-care experts should
be vigilant and cognizant of
these prevailing strategies that
delay the availability of affordable generic drugs and should
advocate for measures to lower
drug prices,” Mr. Jones and coauthors concluded.
But are there any solutions
in sight? Mr. Jones and authors
proposed several strategies the
U.S. government and pharmaceutical companies could enact
to tackle the generic availability
issue:
• Allow Medicare to negotiate
drug pricing
• Develop mechanisms to
propose fair pricing for
brand-name and generic
drugs based on the value of
treatment
• Monitor and penalize payfor-delay strategies
• Encourage the presence
of multiple generic drug
companies
• Require that drug companies be more transparent
about the costs of research
and development in order to
justify drug prices
• Challenge weak patents
through government entities
●
REFERENCE
Jones GH, Carrier MA, Silver RT, Kantarjian H. Strategies
that delay or prevent the timely availability of affordable
generic drugs in the United States. Blood. 2016 January 27.
[Epub ahead of print]
Avoiding Heparin:
The First Step to Preventing HIT and HITT
Use of an “Avoid-Heparin Initiative” resulted in
a dramatic reduction in the burden of heparininduced thrombocytopenia (HIT) and associated
costs, according to a report by Kelly E. McGowan,
MD, from the Department of Medicine at the
University of Toronto in Ontario, Canada, and
colleagues.
“Heparin-induced thrombocytopenia is a serious complication of heparin, occurring in up to 5
percent of patients exposed to unfractionated heparin (UFH),” Dr. McGowan and colleagues wrote.
Its treatment involves discontinuing all forms of
heparin and the administration of a non-heparin
anticoagulant, though the recognition and evaluation of suspected HIT is often delayed. Even with
prompt cessation of heparin, complications occur
in 20 to 50 percent of patients, and death or limb
amputation occurs in approximately 5 to 10 percent
of patients.
“This study questions the safety of continuing to expose patients to UFH except in situations
where there is no better alternative,” William
Geerts, MD, the corresponding author of the study,
told ASH Clinical News.
“This study questions
the safety of
continuing to expose
patients to UFH
except in situations
where there is no
better alternative.”
—WILLIAM GEERTS, MD
To potentially lower the incidence of HIT, HIT
with thrombosis (HITT), and HIT-related costs,
the authors developed a hospital-wide strategy of
replacing UFH with low-molecular-weight heparin
(LMWH) for prophylactic and therapeutic indications, including:
• Systematic replacement of most intravenous and
subcutaneous UFH with subcutaneous LMWH
for prophylactic or therapeutic indications
• The remaining use of UFH was for
hemodialysis, intraoperatively for
cardiovascular surgery and in some patients
with acute coronary syndrome
• Replacement of heparinized saline in arterial
and central venous lines with saline flushes
• Modification of order sets to exclude UFH
options
• Removal of UFH stores from most nursing units
The researchers chose LMWH as replacement
therapy because it is associated with a five- to 10fold lower risk of HIT than UFH and thrombosis
is less likely to occur when HIT is triggered by
LMWH than by UFH.
The Avoid-Heparin Initiative was implemented
at Sunnybrook Health Sciences Centre, a tertiarycare hospital in Toronto, Canada, starting in 2006.
Consecutive cases with suspected HIT from 2003
through 2012 were reviewed. Rates of suspected HIT,
adjudicated HIT, HITT, and HIT- &V