| Anti-stroke drugs can make you bleed

Stroke survivors at high risk for bleeding from drugs meant to prevent another stroke can be identified using a new scoring system, new research contends.

Many patients who have an ischaemic stroke – which occurs when a clot blocks blood flow to the brain – are given drugs to prevent another clot. But these anti-clotting medications increase the risk of bleeding problems that can cause disability or death.

Who is most at risk for bleeding?

In the new report, researchers analysed data from six large studies of people who survived a stroke or mini-stroke (transient ischaemic attack). Just over 43 000 people were included in the analysis. Of those, 1 530 had a major bleeding event – defined as bleeding within the skull or that led to death, a hospital stay or disability.

The risk of such an event was 1.9% in the first year and 4.6% over three years, the investigators found.

This report was published online in the journal Neurology.

To predict which patients were most likely to have a major bleeding event, the researchers used 10 factors to create a risk-scoring system:

  • Being male
  • Smoking
  • Taking aspiring with or without dipyridamole or taking aspirin-clopidogrel
  • A high stroke-disability score
  • Having suffered from a prior stroke
  • High blood pressure
  • Low weight
  • Old age
  • Asian ethnicity
  • Diabetes

Age the biggest risk-factor

Age was the biggest predictor of a patient’s risk. The likelihood of bleeding ranged from 2% among 45- to 55-year-olds with no other risk factors to more than 10% for 75- to 85-year-olds with several risk factors, the findings showed.

“The increasing risk of bleeding with older age seems particularly important given the rising number of elderly people with a stroke or mini-stroke,” said study author Dr Nina Hilkens, of University Medical Center Utrecht in the Netherlands.

About 30% of strokes occur in people over 80 years of age, Hilkens noted in a news release from the American Academy of Neurology.

“While the model may help identify people at high risk of major bleeding, it does not aim to guide treatment choices for antiplatelet [anti-clotting] drugs, as the risk of bleeding should always be balanced against the risk of recurrent stroke,” Hilkens said.

Hypertension needs to be controlled

In South Africa, the biggest occurrence of strokes is because of high blood pressure. According to the South African Heart and Stroke Foundation, one in three adults worldwide suffers from hypertension, but will be mostly unaware because of the lack of obvious symptoms.

Legislation has been put into place to reduce the salt intake in South Africa in order to lower the risk of hypertension that leads to stroke and post-stroke bleeding. | ‘I beat cancer, now what?’

One in four South Africans will be affected by cancer in their lifetime through diagnosis of a family member, friend, colleague or themselves. Look around you and count the people sitting in your office – one in four is a high statistic. 

Receiving a cancer diagnosis is terrifying and comes with a multitude of questions – Why me? What did I do wrong? Will treatment work? Where to next?

The treatment will be exhausting – mentally, physically and financially – and incredibly challenging. Then, you hear those words: “You are in remission.”

It’s been a long, tumultuous journey and you’re finally at the end of it – or so you thought. Unfortunately, you may still have a long road ahead of you. 

Remission does not mean the end

“Most cancer survivors are looking forward to leaving the cancer behind and regaining a sense of normality in their lives,” Dr Jill Harris, an oncologist at Cancercare, said at the Cancer Survivors’ Summit held in September 2016.

“But making the transition into the period after treatment can bring new, unexpected challenges, including long-term side effects and ongoing medical costs.”

Guest speaker at the event, Professor Melvyn Freeman, Chief Director: non-communicable Diseases at the Department of Health said, “Surviving cancer is a process of psychological graduation involving personal growth.”

Financial burden

Research shows that about three in every 10 people who recover from cancer will face financial difficulties. Many cancer survivors avoid or delay medical care, miss their follow-up appointments and stop taking medications because they are anxious about costs.

Dr Harris says oncologists should consider offering more economical options with similar outcomes to patients. As a patient, you need to be involved in the decision-making process, especially when it comes to the treatment costs involved. Melvyn Freeman, quote

Fear of recurrence

It’s perfectly normal for cancer survivors to feel anxious or scared about the cancer returning, especially in their first year following treatment. 

Dr Harris suggests that survivors do a genetic test to determine their susceptibility to relapse – if they qualify. 

“I never asked to do this journey, but a journey it became. And it didn’t finish after treatment either,” testicular cancer survivor David Scott told Health24.

“When you have a shadowy ‘death date’, no matter what the prognosis, you still believe you could be the percentile that doesn’t make it. Or that your body does not respond to chemo.”

Chronic fatigue

Persistent fatigue is a long-term effect experienced by 30% to 40% of patients cured of cancer and can continue for years following treatment, says the National Cancer Institute in the US.

Exercise is one of the more successful treatment options to help address cancer-related fatigue. Dr Harris says the combination of exercise, cognitive therapy and coping skills training are a good way to combat cancer-related fatigue.

“It’s also important to remember that everybody’s treatment and recovery are different, so you shouldn’t compare yourself with other patients or you may end up feeling hopeless,” breast cancer survivor Wilma van der Bijl previously told Health24.

“I never thought I’d bounce back but, although it takes time, you come through the experience and regain your energy and lust for life.”

Life after cancer 

Cancercare believes cancer survivors should be celebrated and will host its annual Cancer Survivors Day in September 2017. Cancer survivors need ongoing support. 

“The goal is to give us the opportunity as a practice to acknowledge the people who are treated with us and to recognise the journey they have undertaken with cancer,” says Linda Greeff, oncology social worker, Cancercare Rondebosch.

“It is also a chance for us to raise awareness around the fact that this illness can be treated and that people can live long and productive lives with cancer.”

The day is designed to break the stigma that cancer is a life-threatening illness, while sharing inspirational cancer survivors’ stories. “Being around other cancer survivors inspires and motivates people,” says Greeff. 

Two women hugging

“The feedback we have received every year has been overwhelmingly positive. People feel that they are not alone in their experiences and they use this as a chance to learn from one another. It is also a special experience for our treatment teams as they get to connect with their patients and see how they are getting on with their lives.”

Greeff concludes, “From the moment you receive your diagnosis, you are a survivor, and this day is for you.”

For more information or if you’d like to attend the Cancer Survivors Day, you can email Joleen Retief.

All images provided by iStock.