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Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Resumption of anticoagulation after major bleeding decreases the risk of stroke in patients with atrial fibrillation
This study aimed to (1) evaluate anticoagulation use after a major bleeding event on dabigatran or warfarin and (2) compare outcomes between patients discontinuing anticoagulation and those restarting dabigatran or warfarin. Methods This was...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Smit, M. D., Van Gelder, I. C. Tags: Therapeutics/Prevention Source Type: research
Aspirin prophylaxis in people without prior cardiovascular disease does not lead to reductions in cardiovascular death or cancer mortality
Commentary on: Seshasai SR, Wijesuriya S, Sivakumaran R, et al.. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 2012;172:209–16. Context Prophylactic antiplatelet therapy with aspirin reduces the risk of non-fatal myocardial infarction (MI), non-fatal stroke and vascular death in patients with known cardiovascular disease (CVD) and is of net benefit. The absolute reduction in recurrent events significantly exceeds the increase in major bleeding.1 However, the role of aspirin in primary prevention of CVD is not clear. According to the Antithrombot...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Farooq, M. U., Gorelick, P. B. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Prevention, Ischaemic heart disease Online articles Source Type: research
Lack of association between proton pump inhibitors and adverse events in patients taking clopidogrel and aspirin
Commentary on Douglas IJ, Evans SJ, Hingorani AD, et al.. Clopidogrel and interaction with proton pump inhibitors: comparison between cohort and within person study designs. BMJ 2012;345:e4388 Context Clopidogrel inhibits the P2Y12 platelet receptor and is used in patients with acute coronary syndromes or ischaemic stroke to prevent recurrent vascular events. Proton pump inhibitors (PPIs), however, have been shown to reduce the pharmacodynamic effect of clopidogrel upon platelet inhibition, and have been linked in retrospective studies to a higher rate of ischaemic outcomes in patients taking clopidogrel. Methods A total o...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Waksman, R., Gaglia, M. A. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Health education, Smoking Aetiology Source Type: research
Coronary revascularisation in patients with diabetes: a chance to be better
Commentary on: Farkouh ME, Domanski M, Sleeper LA, et al.. Strategies for multivessel revascularisation in patients with diabetes. N Engl J Med 2012;367:2375–84. Context In 2009, a pooled analysis of individual patient data from randomised clinical trials comparing percutaneous coronary interventions (PCI) with coronary artery bypass grafting (CABG) showed a survival benefit in favour of CABG.1 Techniques of both PCI and CABG evolved during the last decade with the use of drug-eluting stents (DES) and novel antiplatelet agents. Methods In the FREEDOM trial, patients with diabetes and multivessel coronary artery disea...
Source: Evidence-Based Medicine - November 21, 2013 Category: Internal Medicine Authors: Windecker, S., Stefanini, G. G. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease Therapeutics Source Type: research
Novel anticoagulants in patients with mechanical heart valves
Commentary on: Eikelboom JW, Connolly SJ, Brueckmann M, et al.. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med 2013;369:1206. Context Novel anticoagulants (including the direct thrombin inhibitor dabigatran etixilate) and oral factor Xa inhibitors have similar or superior efficacy and safety to warfarin for reducing thromboembolic stroke in patients with atrial fibrillation, and for prevention of deep venous thrombosis. Eikelboom and colleagues set out to examine whether these novel anticoagulants could be used as an alternative to warfarin in patients with mechanical heart valves. Method...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Stewart, R. A. H. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism Therapeutics Source Type: research
Metformin associated with better cardiovascular outcomes than other glycaemic therapies
Context A question exists as to whether the outcome of glycaemic treatment of diabetes varies with the agent used; speculation surrounds whether metformin might be preferable to other treatments. Methods Ghotbi and colleagues performed an epidemiological analysis of 8192 obese patients with diabetes at increased cardiovascular risk participating in the Sibutramine Cardiovascular OUTcomes (SCOUT) trial. Mortality and a combined cardiovascular outcome of non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest or cardiovascular death were compared among those receiving one of the following interv...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Bloomgarden, Z. T. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Heart failure, Stroke, Hypertension, Diet, Obesity (nutrition), Ischaemic heart disease, Diabetes, Health education, Smoking Therapeutics Source Type: research
Citalopram decreases agitation in the context of Alzheimer's disease, but at doses higher than those commonly prescribed and at the expense of side effects
Commentary on: Porsteinsson AP, Drye LT, Pollock BG, et al.. Effect of citalopram on agitation in Alzheimer disease. The CitAD randomised clinical trial. JAMA 2014;311:682–91. Context By 2050, an estimated 135 million people will suffer from dementia globally.1 Caring for those with Alzheimer's disease (AD)—by far the most common form of dementia—is expensive, costing an estimated £23 billion per annum in the UK. As the disease progresses, neuropsychiatric symptoms such as depression, agitation and behavioural disturbance appear. The incidence of these symptoms, which predict institutionalisation an...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Underwood, B. R., Fox, C. Tags: Neurogastroenterology, Geriatric medicine, Dementia, Drugs: CNS (not psychiatric), Sleep disorders (neurology), Stroke, Drugs: psychiatry, Eating disorders, Memory disorders (psychiatry), Psychiatry of old age, Psychotic disorders (incl schizophrenia), Sl Source Type: research
Fruit and vegetable consumption is associated with reduced all-cause and cardiovascular mortality
Commentary on: Wang X, Ouyang Y, Liu J, et al.. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2014;349:g4490 Context Dietary guidelines from around the world recommend the daily consumption of a variety of fruits and vegetables. For example, the ‘5 a day’ public health campaign in the UK encourages people to consume at least five 80 g portions of fruits and vegetables every day. These guidelines are largely based on recommendations from the WHO to consume at least 400&nb...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Crowe, F. L. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Diet, Ischaemic heart disease, Health education, Smoking Therapeutics/Prevention Source Type: research
Bypass surgery is more cost-effective than percutaneous coronary interventions for most patients with multivessel or left main coronary artery disease
Commentary on: Cohen DJ, Osnabrugge RL, Magnuson EA, et al; SYNTAX Trial Investigators. Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with 3-vessel or left main coronary artery disease: final results from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 2014;130:1146–57. Context The SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) trial compared outcomes of percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary a...
Source: Evidence-Based Medicine - March 17, 2015 Category: Internal Medicine Authors: Agarwal, S., Kapadia, S. R. Tags: Health policy, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Health economics, Health service research Economic analysis Source Type: research
Blood pressure lowering in patients with type 2 diabetes improves cardiovascular events including mortality, but more intensive lowering to systolic blood pressure less than 130 mm Hg is associated with further reduction in stroke and albuminuria without further reduction in cardiac events
Commentary on: Emdin CA, Rahimi K, Neal B, et al. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA 2015;313:603–15. Context Hypertension and diabetes are independent risk factors for cardiovascular disease.1 Although lowering blood pressure (BP) reduces cardiovascular events,1 thresholds to initiate antihypertensive therapy and BP targets have been areas of controversy. Until recently, guideline recommendations for BP targets have been more stringent in patients with diabetes. Methods Emdin and colleagues report information from a systematic review of 45 randomised trials. The t...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Toklu, B., Bangalore, S. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Renal medicine, Diabetes Therapeutics/Prevention Source Type: research
Interruption of all anticoagulation is non-inferior to the use of short-term parenteral bridging in patients with atrial fibrillation undergoing invasive procedures
Commentary on: Douketis JD, Spyropoulos AC, Kaatz S, et al., BRIDGE Investigators. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 2015;373:823–33 . Context Oral anticoagulation (OAC) has been demonstrated to reduce stroke in patients with atrial fibrillation (AF), however, its use conveys an increased risk of bleeding.1 Therefore, patients receiving OAC who undergo invasive procedures often ‘interrupt’ OAC. Use of short-term ‘bridging’ anticoagulants during such interruptions has been the source of significant debate.2 Although guidelines support a ri...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Steinberg, B. A. Tags: Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Valvar diseases, Arrhythmias Therapeutics/Prevention Source Type: research
At 5 years, transcatheter aortic valve replacement had similar rates of mortality and stroke as surgical aortic valve replacement in high-risk patients
Commentary on: Kapadia SR, Leon MB, Makkar RR, et al., PARTNER trial investigators. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015;385:2485–91 and Mack MJ, Leon MB, Smith CR, et al., PARTNER 1 trial investigators. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER1): a randomised controlled trial. Lancet 2015;385:2477–84. Context When calcific aortic stenosis is as...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Reardon, M. J., Kleiman, N. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Heart failure, Stroke, Interventional cardiology, Valvar diseases Therapeutics/Prevention Source Type: research
Intermediate and long-term cognitive effects in older adults secondary to cardiovascular procedures is uncommon but current evidence is insufficient
Commentary on: Fink HA, Hemmy LS, MacDonald R, et al. Intermediate- and long-term cognitive outcomes after cardiovascular procedures in older adults: a systematic review. Ann Intern Med 2015;163:107–17 . Context Cardiovascular procedures are common in the older population.1 There is suspicion that these procedures may have a negative outcome on cognition.2 However, further research has indicated that there may have been pre-existing cognitive deficits as cognitive impairment is common in the older population.3 This systematic review examines the evidence of the relationship of coronary and carotid revascularisation, ...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Charles, L. Tags: Health policy, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Dementia, Stroke, Interventional cardiology, Memory disorders (psychiatry), Radiology, Clinical diagnostic tests, Health service research Aetiology/Harm Source Type: research
ACE inhibitors in African Americans with hypertension associated with worse outcomes as compared to other antihypertensives
Commentary on: Bangalore S, Ogedegbe G, Gyamfi J, et al.. Outcomes with angiotensin-converting enzyme inhibitors vs other antihypertensive agents in hypertensive blacks. Am J Med 2015;128:1195–203. Context Hypertension affects one-third of the world's population and remains a leading cause of myocardial infarction, stroke, heart failure, renal failure and death. Although hypertension control has improved,1 the prevalence is increasing due to an ageing population, rising obesity and a shift towards western lifestyles and disease patterns in low-income and middle-income countries. Hypertension is now also a major contr...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Lund, L. H. Tags: EBM Prognosis, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Obesity (nutrition), Ischaemic heart disease, Renal medicine, Drugs: musculoskeletal and joint diseases, Health education Source Type: research
Ultrasound-guided corticosteroid injections for adhesive capsulitis more effective than placebo
Commentary on: Prestgaard T, Wormgoor ME, Haugen S, et al.. Ultrasound-guided intra-articular and rotator interval corticosteroid injections in adhesive capsulitis of the shoulder: a double-blind, sham-controlled randomized study. Pain 2015;156:1683–91. Context Adhesive capsulitis (frozen shoulder or painful stiff shoulder) is relatively common. It is idiopathic: known associated factors include trauma, diabetes, prolonged immobilisation, age, stroke and autoimmune disease. While self-limited, pain and decreased range of motion can last up to 2–3 years. Therefore, there is practical value in therapeutic in...
Source: Evidence-Based Medicine - March 21, 2016 Category: Internal Medicine Authors: Lebrun, C. M. Tags: Rehabilitation medicine, Immunology (including allergy), Pain (neurology), Stroke, Radiology, Degenerative joint disease, Musculoskeletal syndromes, Osteoarthritis, Sports and exercise medicine, Clinical diagnostic tests, Radiology (diagnostics), Screenin Source Type: research
