About 35% or 500 out of 100 000 strokes that occur in South Africa every year can now be prevented. This is thanks to a new drug registered for use in the country this week for the prevention and management of strokes in people with a heart condition known as Atrial Fibrillation.
Sufffering a stroke is becoming more common in South Africa, affecting about 130 people a day. About half the people who suffer a stroke are likely to die within the first year of having it. Adults over the age of 40 are at highest risk. This is because 1 in 4 adults over 40 are more likely to suffer a heart condition known as atrial fibrillation, which is responsible for a third of all strokes. Dr Kevin Ho, the Medical Director at Boehringer-Ingelheim, explains that atrial fibrillation is a condition where the normal heart beat is affected and becomes irregular.
“Atrial fibrillation is the commonest cardiac arythmia or rhythm disturbance of the heart and the significance of atrial fibrillation in stroke is that it increases the risk of stroke five-fold and is also associated with particularly severe and disabling strokes. Atrial fibrillation is the condition where the upper chambers of the heart tend to behave very erratically. There’s a very dis-coordinated electrical conduction. As a result, there’s no effective pumping of the blood from the upper chambers into the ventricle, which is the main muscular pump of the heart. And, as a result of that, one tends to get pulling and stasis of blood within the atrial appendage, which is a structure in the upper chamber. That, then, is where the risk of developing a clot occurs and with that, the risk of it embolising or breaking off to essentially shoot through to the blood vessels and circulation supplying the brain and, in so doing, cause a stroke”, says Dr Ho.
He says Boehringer-Ingelheim sought to develop a new drug to prevent the development of blood clots in the heart area. The drug, whose trade name is Pradaxa, is prescribed to be taken orally twice daily.
“It prevents clots developing, particularly, in the upper chambers of the heart – the so-called the atrial appendage. By thinning the blood, it prevents the development of clots and, thereby, reduces the risk of developing a stroke in patients with atrial fibrillation”.
There are two types of strokes, namely the ischaemic stroke and the haemorrhagic stroke and the one commonly associated with atrial fibrillation is the ischaemic stroke. Dr Ho says Pradaxa has been found to be effective in both.
“The haemorrhagic stroke is less common - 15%. Nevertheless, it is a potential complication of atrial fibrillation and a known sub-type of stroke itself. And that, essentially, is where one of the blood vessels within the brain ruptures and causes bleeding within the brain itself. We’ve also been able to show a dramatic and significant reduction of intra-cranial haemorrhage and haemorrhagic stroke with the new drug as well”, he says.
Until recently, there have been two ways to prevent a stroke – the use of a drug known as Warfarin and aspirin. But observational research has since proven that aspirin is totally ineffective in preventing strokes.
Warfarin has been a challenge as it can cause severe bleeding and patients need to be constantly monitored. Dr Vash Mungal-Singh, Chief Executive Officer of the Heart and Stroke Foundation, says the new drug, Pradaxa will bring much relief.
“The greatest challenge around Warfarin is the practicality. If you consider that the vast majority of South Africans live in poorer communities and they are particularly affected with this problem of stroke… the treatment of Warfarin is really difficult in such patients because they don’t have access to health care facilities, they’re unable to go on a weekly or every second week or monthly basis to have their blood tested and if you consider that a lot of these patients live in rural areas as well, it’s very difficult to reach them. Now you have a drug that doesn’t need monitoring and that is safer from a health perspective”, says Dr Vash Mungal-Singh.
George Scola, the founder of The Stroke Survivors Foundation, suffered a stroke six years ago at a relatively young age of 37 and now walks with some difficulty because of the paralysis on one side of his body and also struggles with his speech. Scola adds that Pradaxa is a much needed intervention.
“I agree fully”. Scola says.
“The fact that you don’t have to control it regularly… In the rural areas in most cases, what happens is that a stroke survivor basically gives up, and that’s the last thing you can do as a stroke survivor. Making it easier to medicate will go a long in contributing to the mental aspect and the fight that you have to put in to recover from a stroke”, he adds.
Pradaxa started becoming available in South Africa this week. A monthly package costs R649, excluding tax. Scola laments that this could make the drug far out of reach for the majority of people who need it.
If you look at the numbers that stroke affects – we’re talking about 130 people a day, government’s got to do something and come to this party because those kinds of numbers can jump out of proportion very quickly. And when you’re sitting with a whole nation of disabled people that are not contributing to the economy… it’s a time bomb, I think”, says Scola.