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URI Visit Hacker News on the Web
COMMENT PAGE FOR:
URI EpiPen For Heart Attacks? Idorsia Launches Phase III Study Of Selatogrel (2021)
TylerJaacks wrote 10 hours 53 min ago:
I was looking into this and haven't seen much news of late. This would
be an amazing product if widely available. Unfortunately knowing the
current state of US pharmaceuticals, this would cost the price of your
mortgage.
pipes wrote 20 hours 51 min ago:
I've recently started keeping aspirin in my pockets because I've been
getting unexplained horrible chest pain issues. I'm only in my forties.
ww520 wrote 19 hours 26 min ago:
Go to hospital to get it checked out right the way. Go to ER if
needed.
Your body is desperately trying to tell you something. Listen to it.
pipes wrote 18 hours 52 min ago:
I went to A&E (ER in the UK). They did two ECGs and said they
thought I was ok.
A month a go I discovered I'm borderline anemic (a consultant
hematologist diagnosed this) but I've been told chest pain
unrelated because that only happens with severe anemia.
God knows what's wrong.
I was sitting in my car, and it feels like a fist pushing into my
chest.
Madmallard wrote 18 hours 21 min ago:
Sounds like angina. Youâre gonna want to get that more
thoroughly evaluated. Stress test, blood work, echocardiogram,
chest xray, etcâ¦
pipes wrote 9 hours 20 min ago:
I think you are probably right. (Or you a medic by any chance)
Edit, looking on NHS website, angina symptoms come on during
exercise. This was happening while still.
Edit2: actually no, unstable angina can come on anytime
Arrath wrote 19 hours 58 min ago:
My friend you're going to want to get that checked out.
My dad thought he pulled a muscle in his chest and popped some
aspirin and kept truckin', in was only later when his leg started
swelling and turning all kinds of nasty colors that he bothered to go
to the hospital.
Turned out that a workplace injury had resulted in DVT, and he had
gritted his teeth through two pulmonary embolisms.
Still kicking to this day, largely in thanks to him finally getting
the issue looked at.
SketchySeaBeast wrote 20 hours 47 min ago:
You, uh, don't want to get out ahead of that a bit?
carlsborg wrote 23 hours 31 min ago:
This gentleman, Jean-Paul Clozel, exited to Johnson and Johnson for $30
Billion _cash_. Ex Roche, founded Actelion Pharmaceuticals with his
wife in a rented lab and developed drugs for rare diseases.
esel2k wrote 21 hours 0 min ago:
I worked for him and also on the P2Y12 receptor antagonists. What I
find impressive is that it is his own money that he pumps into it now
as the new company is struggling to survive.
However the company was stretched very thin in too many disease areas
for the size, most of my friends lost their job in the last 6 months.
Glad to see some news as the share price is very low currently.
caycep wrote 1 day ago:
these antiplatelets help a little bit w/ overall risk reduction after a
heart attack, I'd say, but the big game changer would be a clot buster
like an injectable version of alteplase/tenecteplase or something like
that. The caveat is that the better it is at reversing clots, the
higher risk of hemorrhage; alteplase/tenecteplase is typically given in
a critical care/emergency Dept setting w/ surgery/intensivists hovering
over the patient...
Omniusaspirer wrote 9 hours 23 min ago:
You will almost certainly never see at home versions of these drugs,
the risk profile is far too great. Roughly 13% of strokes are
hemorrhagic and that's just the first and most obvious hazard.
anotherboffin wrote 21 hours 25 min ago:
If I remember correctly, part of the goal here is to gain a bit of
time while the patient gets to the ER. Iâm no expert but as you
seem to have alluded to, the risk profile of alteplase/tenecteplase
doesnât seem to be well suited to an autoinjector with âif in
doubt, use it and call the ambulanceâ instructions.
caycep wrote 20 hours 22 min ago:
yeah but then it'll have to compete w/
aspirin/clopidogrel...meaning they're limited on the margins they
can set for the med, and injectables tend to be pricey...
et2o wrote 1 day ago:
None of these works nearly as well as angioplasty
caycep wrote 23 hours 34 min ago:
yes but tpa/tnk is way closer to an angioplasty than selatogrel...
carbocation wrote 1 day ago:
The phrase "auto injector" would have been a much more helpful
substitute for "EpiPen" here.
> Selatogrel is a P2Y12 receptor antagonist
So this is basically like chewing on ticag, but faster.[1]
1 =
URI [1]: https://jamanetwork.com/journals/jamacardiology/fullarticle/26...
babypuncher wrote 18 hours 7 min ago:
Most people don't know what an auto injector is. Everybody knows what
an EpiPen is though.
carbocation wrote 17 hours 25 min ago:
I agree with you that EpiPen is far more widely known. But (in my
opinion) the ambiguity in the title is not worth the name
recognition.
westurner wrote 1 day ago:
Almost otoh, but fwiu: a Vape Pen with (which) cannabinoids may be a
helpful immediate intervention for ischemic Stroke?
Smoking increases risk of stroke and heart attack (MI: Myocardial
Infarction).
Cannabis [smoking?] is associated with heart disease and MI in some
studies but that could be confounding e.g. preexisting hypertension and
other lifestyle factors.
westurner wrote 1 day ago:
(This is relevant to cardiothoraic and geriatric medicine.)
Why don't I just sell AEDs here. AEDs are also a heart attack
intervention. It looks like AEDs are about $800-$2000 USD.
AED: Automated External Defibrilator:
URI [1]: https://en.wikipedia.org/wiki/Automated_external_defibrillat...
tjohns wrote 17 hours 49 min ago:
You absolutely can buy AEDs for home use, and if you're high-risk
it might even be a good idea.
The only reason it's not recommended more widely is cost (they also
need regular maintenance) and likelihood of actually needing it
making it a poor medical value for the general population.
(This is also predicated on having people around who are trained to
use the AED. If you life alone or your family/roommates don't know
how how to use it, it's useless.)
TylerE wrote 15 hours 21 min ago:
I thought the whole point was that you donât need training?
Most of them literally talk you through and and all the
administration is computer controlled.
tjohns wrote 11 hours 5 min ago:
You don't strictly need training to use it, but training is
still strongly recommended if you want to know how to use one
effectively and have the best chance of survival.
At a minimum, you need to know how to perform CPR in between
shocks (or if you don't have a shockable rhythm). Ideally, you
should know how to perform good CPR. The higher end ones will
coach you on performing CPR, but that's definitely not
universal.
Not to mention you need to figure out pad placement, possibly
shave someone's chest (if they're excessively hairy), and
delegate calling 911 to someone.
When seconds count you don't want to be spending minutes
figuring all this out.
westurner wrote 3 hours 33 min ago:
BLS: Basic Life Support > Method: [1] :
> DRSABCD: Danger, Response, Send for help, Airway,
Breathing, CPR, Defibrillation
"Drs. ABCD"
CPR: Cardiopulmonary Resuscitation: [2] CPR > Use of Devices
> Defibrillators, Devices for timing CPR, Devices for
assisting in manual CPR, Devices for providing automatic CPR
(*), Mobile apps for providing CPR instructions: [2] #...
/? CPR training: [4] &tbm=vid
/? AED CPR site:sba.gov [5] SBA.gov blog > Review Your
Workplace Safety Policies:
> Also, consider offering training for CPR to employees. Be
sure to have an automatic external defibrillator (AED) on
site and have employees trained on how to use it. The
American Red Cross and various other organizations offer free
or low-cost training.
URI [1]: https://en.wikipedia.org/wiki/Basic_life_support#Met...
URI [2]: https://en.wikipedia.org/wiki/Cardiopulmonary_resusc...
URI [3]: https://en.wikipedia.org/wiki/Cardiopulmonary_resusc...
URI [4]: https://www.google.com/search?q=cpr+training
URI [5]: https://www.google.com/search?q=site%3Asba.gov+AED+C...
TylerE wrote 21 hours 24 min ago:
I suspect we will be. They were virtually unheard of a decade ago
(and I think the cost was closer to $10k then) but are now more or
less standard kit in new commercial construction.
westurner wrote 3 hours 51 min ago:
/? Is there a recommended placement for an AED wall cabinet
within a facility? [1] > How many AEDs should a facility have?
> When responding to someone who has suffered Sudden Cardiac
Arrest (SCA), immediate action is critical for saving lives. The
sooner that bystanders treat the SCA victim with a defibrillation
shock from an Automated External Defibrillator (AED), the more
likely that they will survive.
> According to [US OSHA], of the 350,000 people who die from SCA
outside the hospital in the United States each year, 10,000 lives
are lost in the workplace. By having defibrillators throughout
offices and facilities, businesses are able to protect the lives
of both their workforce and visitors.
estimated_response_times[0] =
time__to_walk_from_a_central_point * 2
ADA guidelines for AED placement: [2] [3] , AED Placement
Guidelines [PDF] [4] :
> [ height_min: 15" (38cm), max height: 48" (121cm) , max
protrusion: 4" (10cm), side reach: 54" (137cm) ]
And also there are AED backpacks, which are probably easier to
carry through hallways for 6 minutes (given a recommended maximum
of 3 minutes each way)
URI [1]: https://www.google.com/search?q=Is+there+a+recommended+p...
URI [2]: https://www.google.com/search?q=ada+guidelines+AED
URI [3]: https://www.aedbrands.com/resources/implement/where-to-p...
URI [4]: https://www.rescuetraininginstitute.com/wp-content/uploa...
krunck wrote 1 day ago:
Ah yes:
URI [1]: https://www.youtube.com/watch?v=jpMxpzfSRUA
epcoa wrote 1 day ago:
This title appears to be confusing based on a comment: Selatogrel has
nothing to do with epinephrine from a pharmacological standpoint. It
acts more like a super potent quick acting (and deactivating), less
blunt aspirin, an anti-platelet / anti clotting drug. The comparison to
epipen is just the physical delivery.
Epinephrine is not used for heart attacks (MI) directly, but can be
used for cardiac arrest.
babypuncher wrote 23 hours 51 min ago:
I didn't find it confusing. The headline had me thinking "a pen that
instantly delivers a life saving drug in the event of a heart
attack". The EpiPen is a point of comparison most people are familiar
with. The name of the actual drug is even right there in the title
(Selatogrel)
serf wrote 8 hours 17 min ago:
>I didn't find it confusing.
Great!
Anyway there are better comparisons to make if you're just trying
to convey the concept of instantaneous life saving, many examples
of which do not add a confounding additional pharmaceutical to draw
comparisons from.
"Selatogrel: The Life Raft for Heart Attack Emergencies" was the
chat-gpt recommended metaphor for avoiding pharmaceutical
conflation and confusion with EpiPen.
It's basic, but then we wouldn't be discussing why Selatogrel isn't
an EpiPen if the writer had considered it..
starttoaster wrote 21 hours 58 min ago:
It seems like it's maybe obvious what they were getting across to
medical layman like you and me. Seems like it's less obvious to
people that are a bit more in the know on medical jargon.
epcoa wrote 21 hours 7 min ago:
The opposite. Those, "in the know", know that selatogrel is an
anti-platelet medication even if they haven't heard of it
specifically as there is standardization to naming of
pharmaceuticals (the -grel in this case).
The thing about things that "are obvious" is that they are only
that way to a subset of individuals. There were evidently medical
laymen that were confused.
starttoaster wrote 20 hours 42 min ago:
Ah, well I guess it just comes down to one's ability to read
between lines, I guess. More specifically, the ability to read
for the writer's intent rather than what is plainly there. I
was just trying to come up for a nicer explanation to people
that seem to know a lot more about medicine and medical terms
than me being so confused by the title.
epcoa wrote 23 hours 35 min ago:
> I didn't find it confusing.
Ok? As stated, other comments already had exposed there was
confusion.
> The name of the actual drug is even right there in the title
(Selatogrel)
Many non-experts are aware of the general practice of drug
companies patenting "repurposed drugs" or that the same medications
are marketed under different names for different indications (eg
Ozempic, Wegovy and Rybelsus are all the same medication).
I wouldn't expect most non-experts to immediately know that
selatogrel is a generic and not a brand name, especially when it is
being said in the same sentence as a brand name. It is quite
forgivable to assume it might be an alternative trade name for an
epi-pen.
blackhaj7 wrote 1 day ago:
Definitely confusing. I read it as though I could use my epipen if I
had a heart attack (which feels like the opposite of what you should
do)
giantg2 wrote 21 hours 9 min ago:
Epinephrine does constrict small vessels, but I think it dialates
the larger ones. Perhaps there would be some benefit there.
Although an increased heart rate would be very bad if the dilation
and increased BP wasn't able to put enough blood past the
restriction.
bookofjoe wrote 23 hours 40 min ago:
When I posted the article on HN I put EpiPen in quotes to make it
less click-baity; HN's software removed the quotes, thus making it
both confusing and click-baity. I tried....
ImHereToVote wrote 1 day ago:
I wonder if it would be possible to inject the heart with liposomal ATP
directly.
robbiep wrote 20 hours 22 min ago:
Even a cursory exploration into the physiology of atp would
demonstrate the ineffectiveness of this method - the heart consumes
around 6kg of ATP daily, or 250g an hour, which means youâd need to
provide it with more than 4g a minute just to stay pumping in
isolation. Which then leads to the issue of actually delivering the
ATP to the correct part of the heart (god forbid you have a posterior
infarct), and ensuring enough of a quantity to keep pumping after
that first bolus dose of ATP, which isnât going to spread far given
the lack of a distribution system since thereâs some blockage
upstream
bedobi wrote 1 day ago:
pretty sure at least in Sweden they use EpiPens for a bunch of stuff,
including heart attacks already?
percutaneous wrote 1 day ago:
Ahh yes, nothing treats heart hypo perfusion quite like forcing the
heart into overdrive and massive vasoconstriction. Why is the US so
far behind on this???
Edit: sorry I was getting technical. Yes it absolutely has a role in
cardiac arrest and it's used for this the world over.
It would be very detrimental in a patient with a heart attack without
arrest though due to increasing cardiac demand when cardiac supply is
already highly limited
nkozyra wrote 1 day ago:
Aren't epipens used sometimes to restart the heart after cardiac
arrest, though?
I don't think it's the first tool from the toolbox, but I'm pretty
sure epinephrine has use here.
dghughes wrote 1 day ago:
I'm not a doctor or in the medical field but I've read injected
lidocaine is used to treat ventricular fibrillation.
I don't know if it's true but I am sure I also once read that
lidocaine can cause a heart attack but if having one can help
stop the heart attack.
epcoa wrote 23 hours 7 min ago:
Ventricular Fibrillation is not a heart attack (heart attack is
already an imprecise lay term) but I don't think encouraging
it's use for anything other than acute myocardial ischemia is a
good idea. In that sense, lidocaine doesn't stop a heart
attack.
A heart attack may lead to arrhythmias like VF. But VF is not a
heart attack.
Lidocaine is a sodium channel blocker, it controls arrhythmias
by blocking or diminishing the disorganized electrical activity
going on in heart while hopefully not squelching whatever
remaining dominant organized pacemaker activity there is.
It is not the only antiarrhythmic though and relatively not a
common one even for VF, it is not generally first line in its
class. It's role in life support is a complicated subject but
it is an optional drug for use in in-hospital CPR (ACLS) for
VT/VF. High quality CPR and defibrillation are far more
important though.
percutaneous wrote 23 hours 49 min ago:
It's not often used for what's classically considered heart
attacks, but it's a fun drug that can both cause and fix
certain arrhythmias!
ejstronge wrote 1 day ago:
> Ahh yes, nothing treats heart hypo perfusion quite like forcing
the heart into overdrive and massive vasoconstriction. Why is the
US so far behind on this???
This is actually quite reasonable, especially if itâs paired with
an existing defibrillator. Epinephrine is part of the advanced,
cardiac life support algorithm, but itâs just not used in a pen
format, since ACLS is typically performed in the hospital setting.
[1] Edit:
Recently, in the news, there was a discussion of using ECMO in the
setting of patients who would require CPR. Take a look at this
article for more:
URI [1]: https://cpr.heart.org/-/media/CPR-Images/CPR-Guidelines-Im...
URI [2]: https://www.nytimes.com/2024/03/27/magazine/what-to-know-e...
refurb wrote 1 day ago:
Cardiac arrest is not the same as cardiac hypoperfusion (what
people commonly call a heart attack), but it can a be a
consequence of it.
Heart attacks are due to blockage of blood flow to the heart.
That can cause the heart to stop (cardiac arrest) but not always.
binarymax wrote 1 day ago:
Hereâs the ongoing trial info:
URI [1]: https://clinicaltrials.gov/study/NCT04957719
jdawg777 wrote 1 day ago:
> will be supplied with an auto-injector, containing either 16mg of
selatogrel or a placebo liquid formulation.
Its unfortunate that half the trial patients are getting a placebo,
especially when it is life or death, but I suppose that's how drug
trials work.
LorenPechtel wrote 20 hours 50 min ago:
But you don't know if the new drug is going to be better or worse.
Sometimes the placebo arm has a better outcome than the drug arm.
And, unfortunately, sometimes they really mess up the statistics.
Consider that huge trial from some years ago that declared hormone
replacement for menopause symptoms definitely bad. No, despite the
huge size of the study they made a fundamental mistake in recruiting
participants--all that study actually proved is what was long known:
fat women shouldn't be on hormone replacement.
sp332 wrote 1 day ago:
Off the top of my head, maybe the shock of being jabbed with a needle
would have an effect on people's symptoms that should be controlled
for.
bookofjoe wrote 23 hours 35 min ago:
It IS controlled for: ALL participants get jabbed with a needle.
sp332 wrote 23 hours 19 min ago:
Right, that's why you need to load some needles with a placebo.
bookofjoe wrote 22 hours 32 min ago:
Participants receiving placebo get the placebo through a
needle.
sp332 wrote 22 hours 3 min ago:
Yes. I'm in favor of this.
jprete wrote 1 day ago:
The alternative is to see later studies like [1], which finds that
several popular heart interventions don't actually improve all-cause
mortality in the population of "severe but stable" heart disease
patients.
If stents and coronary bypasses don't increase life expectancy (or
quality of life!) for that population, then a lot of people from that
population took the risks of major surgery for no benefit.
URI [1]: https://med.stanford.edu/news/all-news/2019/11/invasive-hear...
bookofjoe wrote 1 day ago:
FWIW, often a trial is halted before being completed if statistical
analysis of the preliminary results definitively indicate a positive
outcome, or unexpected negative/life-threatening side effects emerge
at an unacceptably high incidence.
If the trial is halted prematurely because the drug is deemed
effective, immediately all individuals who received placebo are given
the real thing. If the trial is completed and it shows the drug is
effective, all those who received placebo are given the real thing.
Know also that all participants are paid for participating.
Temporary_31337 wrote 1 day ago:
So are they going to wait with their heart attack until trial is
over? Maybe read the article first? This makes sense for long term
medicine like diabetes drugs etc but this one is for heart attack
LorenPechtel wrote 20 hours 45 min ago:
Suspect heart attack--you head to the hospital pronto. The trial
involves injecting the drug immediately, then going to the
hospital. The placebo arm gets exactly the same treatment
everyone would get now--rush to the hospital. This drug is
purely about trying to keep the heart alive long enough to reach
the hospital. A hospital with a cath lab is a far better
treatment than this drug--but you can't put that in your pocket.
bookofjoe wrote 1 day ago:
Yes. That is how clinical trials work. I have run many clinical
trials. I read the article twice before I submitted it.
epcoa wrote 1 day ago:
I think the charitable interpretation of who you are replying
to is that it would be silly to give this drug for an acute
event to people that received control (a life-long standard
anti-platelet) weeks after they had an MI event. You're not
going to say, oh that guy that had a heart attack and PCI 4
weeks ago who is on DAPT, oh now we're going to give this drug,
the horse has already left the barn so to speak and the
intervention is no longer indicated. That's how I interpreted
the point at least.
stephencanon wrote 1 day ago:
The standard joke here is that the researcher objects to the need for
a trial, saying âthat would be condemning half my patients to
death!â and a medical student asks âwhich half?â
crubier wrote 1 day ago:
This is how all drug trial works.
And it regularly ends up being not-so-unfortunate, when the drug
turns out to have dangerous side effects that overshadow its
benefits.
throwup238 wrote 1 day ago:
Not all. The need for a placebo control is weighed against ethics
and whether a placebo is even realistic.
Chemotherapy drug trials often just use standard treatments as a
control group. Theyâre likely using placebo here because
thereâs no other drug in its class yet. Normally emergency life
or death trials donât have placebos unless the treatment is the
first of its kind.
ano-ther wrote 1 day ago:
Yes. And placebo control is actually quite a weak standard (=
better than nothing). Ideally, there should be more head-to-head
studies.
Alas, they are also more likely to fail (and give the competition
data) so developers avoid them, at least for the initial
approval.
LorenPechtel wrote 20 hours 40 min ago:
And it's something the FDA shouldn't be allowing.
You want to bring a new drug to market, you should be required
to demonstrate that it's not strictly inferior to existing
options in at least some patients. I'm fine with a
head-to-head that comes out a tie (competition is good for the
marketplace) and I'm fine with a drug that only works in a
subset if that subset can be identified. And I'm fine with a
drug that doesn't work as well but is more tolerated. I'm not
fine with a drug that loses in all respects in a head-to-head.
throwup238 wrote 14 hours 0 min ago:
That's far too strict. It doesn't do anyone any good to
reject less effective drugs unless the safety to efficacy
ratio is way off. Most drugs are relatively safe compared to
the diseases they treat and identifying the subset that they
work for is beyond our capability at the moment (i.e. the
entirety of psychiatric medicine).
The FDA drug/therapy pipeline is supposed to give downstream
users like doctors, public health officials, and patients
more options within a certain risk profile. They're not
supposed to be the be-all-end-all of treatment options.
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