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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
New reversal agent for factor Xa inhibitors shows promise
Commentary on: Siegal DM, Curnette JT, Connolly SJ, et al.. Andexanet alfa for the reversal of Factor Xa inhibitor activity. N Engl J Med 2015;373:2413–24. Context Direct oral anticoagulants (DOACs) have emerged as alternatives to vitamin K-antagonists (eg, warfarin) for the long-term management of stroke prevention for non-valvular atrial fibrillation or venous thromboembolic disease. Favourable side-effect profiles and absence of therapeutic monitoring are important benefits of these newer agents. Warfarin is readily reversed with fresh frozen plasma (FFP) or prothrombin complex concentrates.1 The first reversal ag...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Ghadimi, K., Welsby, I. J. Tags: Clinical trials (epidemiology), Immunology (including allergy), Drugs: cardiovascular system, Stroke, Venous thromboembolism, Unwanted effects / adverse reactions Therapeutics/Prevention Source Type: research
Insomnia is associated with risk of future cardiovascular events irrespective of comorbidities
Commentary on: Hsu CY, Chen YT, Chen MH, et al.. The association between insomnia and increased future cardiovascular events: a nationwide population-based study. Psychosom Med 2015;77:743–51. Context Increasing evidence suggests a relatively strong association between insomnia and risk of future cardiovascular events. However, the exact nature of this association is poorly understood and causality remains uncertain due to methodological limitations in prior literature. An important methodological shortcoming was the inadequate consideration of comorbidities in several previous studies. Insomnia symptoms clearly over...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Janszky, I. Tags: EBM Prognosis, Geriatric medicine, Health policy, Epidemiologic studies, Drugs: cardiovascular system, Epilepsy and seizures, Sleep disorders (neurology), Stroke, Ischaemic heart disease, Drugs misuse (including addiction), Sleep disorders, Sleep disorder Source Type: research
Preoperative treatment with {beta}-blockers is associated with elevated postoperative mortality and cardiac morbidity in patients with uncomplicated hypertension undergoing non-cardiac surgery
Commentary on: Jørgensen ME, Hlatky MA, Køber L, et al.. β-Blocker-associated risks in patients with uncomplicated hypertension undergoing noncardiac surgery. JAMA Intern Med 2015;175:1923–31. Context The role of β-blockers in preventing cardiovascular complications of non-cardiac surgery is controversial. Early enthusiasm was dampened by accumulating trial data and concerns about the scientific validity of several trials. When studies with uncertain validity are excluded, meta-analyses of randomised trials show that perioperative β-blockers (started within 1 day before surgery) prev...
Source: Evidence-Based Medicine - May 22, 2016 Category: Internal Medicine Authors: Wijeysundera, D. N. Tags: Liver disease, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Chemotherapy, Ischaemic heart disease Aetiology/Harm Source Type: research
Restarting oral anticoagulation among patients with atrial fibrillation with gastrointestinal bleeding was associated with lower risk of all-cause mortality and thromboembolism
This study assesses risks of all-cause mortality, thromboembolism, major bleeding and recurrent GIB associated with resuming antithrombotic treatment after GIB among patients with AF. Methods This prospective cohort study included non-valvular patients with AF who experienced GIB while receiving single or combined antithrombotic treatment with an antiplatelet and/or anticoagulant in a Danish cohort from 1996...
Source: Evidence-Based Medicine - July 25, 2016 Category: Internal Medicine Authors: Qureshi, W. T., Nasir, U. Tags: EBM Prognosis, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Stroke, Venous thromboembolism, Pulmonary embolism Source Type: research
Liraglutide, a GLP-1 receptor agonist, prevents cardiovascular outcomes in patients with type 2 diabetes
Commentary on: Marso SP, Daniels GH, Brown-Frandsen K, et al.. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016;375:311–22 . Context Despite the treatments available for type 2 diabetes, about two-thirds of these patients die from associated heart disease or stroke.1 Approval of the first glucagon-like peptide-1 agonist (GLP-1), exenatide, by the FDA in 2005 generated an expectation that the clinical outcomes in type 2 diabetes would be improved. However, we still do not have definitive evidence that exenatide does this, although a clinical trial to determine this, the Exenatide Study of ...
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Doggrell, S. A. Tags: Pancreas and biliary tract, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Therapeutics/Prevention Source Type: research
Intensive treatment of hypertension to a SBP
Commentary on: Williamson JD, Supiano MA, Applegate WB, et al.. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years. A randomized clinical trial. JAMA 2016;315:2673–82 . Context There is uncertainty regarding optimal blood pressure (BP) targets in treating hypertension. Most recent guidelines have recommended a systolic target of <140 mm Hg. The Systolic Blood Pressure Intervention Trial (SPRINT) compared cardiovascular (CV) outcomes in non-diabetic hypertensive patients randomised to standard (systolic blood pressure (SBP) <140 mm&nbs...
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Weber, M. A. Tags: Palliative care, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Renal medicine, Ethics Therapeutics/Prevention Source Type: research
Economic evaluation of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) for stroke prevention in patients with atrial fibrillation: a systematic review and meta-analysis
Conclusions
Our meta-analysis provides comprehensive economic evidence that allows policy makers to generalise cost-effectiveness data to their local context. All DOACs may be cost-effective compared with VKA in HICs with TPP perspective. The pooling results produced moderate to high heterogeneity particularly in UMICs. Further studies are required to inform UMICs with SP.
PROSPERO registeration number
CRD 42019146610.
Source: Evidence-Based Medicine - July 28, 2022 Category: Internal Medicine Authors: Noviyani, R., Youngkong, S., Nathisuwan, S., Bagepally, B. S., Chaikledkaew, U., Chaiyakunapruk, N., McKay, G., Sritara, P., Attia, J., Thakkinstian, A. Tags: Open access Evidence synthesis Source Type: research
In patients with intracerebral haemorrhage and concomitant atrial fibrillation, optimal timing of reinitiating anticoagulants may be 7-8 weeks after ICH
Commentary on: Pennlert J, et al. Optimal timing of anticoagulant treatment after intracerebral haemorrhage in patients with atrial fibrillation. Stroke 2017:48;314–320. Context In patients with intracerebral haemorrhage (ICH) and a concomitant diagnosis of atrial fibrillation (AF), the clinical dilemma arises whether anticoagulant treatment should be (re)started and when.1 In the absence of results from randomised controlled trials, guidelines provide no firm recommendations. Several observational studies have suggested that reintroduction of oral anticoagulants may be associated with a reduction in thrombotic ...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Klijn, C. J., Schreuder, F. H. Tags: Therapeutics/Prevention Source Type: research
Dabigatran associated with increased risk of acute coronary events
Commentary on: Uchino K, Hernandez AV. Dabigatran association with higher risk of acute coronary events: meta-analysis of noninferiority randomized controlled trials. Arch Intern Med 2012;172:397–402. Context The novel oral anticoagulants, comprised of direct thrombin inhibitors (DTIs) (ie, dabigatran) and the factor Xa inhibitors (ie, rivaroxaban, apixaban and edoxaban), are revolutionising the way patients are anticoagulated. Recent years have witnessed a surge of trials evaluating these drugs in many clinical contexts. However, with such rapid uptake, it becomes critical to carefully evaluate safety data in order ...
Source: Evidence-Based Medicine - January 17, 2013 Category: Internal Medicine Authors: Kohli, P., Cannon, C. P. Tags: Electronic pages Source Type: research
Single-tablet double-dose famotidine plus ibuprofen decreases endoscopic upper GI ulcers compared with ibuprofen alone
Commentary on: Laine L, Kivitz AJ, Bello AE, et al.. Double-blind randomized trials of single-tablet ibuprofen/high-dose famotidine vs. ibuprofen alone for reduction of gastric and duodenal ulcers. Am J Gastroenterol 2012;107:379–86. Context Non-steroidal anti-inflammatory drugs (NSAID) are widely prescribed worldwide. However, NSAID use frequently accompanies gastrointestinal (GI) injury including complications such as bleeding and perforation. Therefore co-therapy with gastroprotective drugs especially for those at risk has been advocated in current guidelines1 in which proton-pump inhibitors (PPI) and misoprostol ...
Source: Evidence-Based Medicine - January 17, 2013 Category: Internal Medicine Authors: Sugano, K. Tags: Clinical trials (epidemiology), Small intestine, Stomach and duodenum, Drugs: cardiovascular system, Stroke, Drugs: musculoskeletal and joint diseases Therapeutics Source Type: research
Prophylactic dose fondaparinux for 6 weeks in superficial thrombophlebitis of the legs reduces the risk for symptomatic thromboembolic complications
Commentary on: Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2012;3:CD004982. Context Superficial thrombophlebitis (ST), an inflammatory-thrombotic disorder in a superficial vein, is relatively common and estimated to occur in 1 per 1000 persons.1 The classic symptoms include pain, oedema, erythema and occasionally a palpable cord in the area of the thrombosed vein. Risk factors for ST include surgery, pregnancy and puerperium, female hormones, malignancy, infection, varicose veins, autoimmune disorders and thrombophilia.2 ST is a risk factor for dee...
Source: Evidence-Based Medicine - January 17, 2013 Category: Internal Medicine Authors: DeSancho, M. T., Pastores, S. M. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Pain (neurology), Stroke, Pregnancy, Venous thromboembolism, Renal medicine, Pulmonary embolism, Drugs: musculoskeletal and joint diseases, Dermatology Therapeutics Source Type: research
Oral treatment of acute pulmonary embolism with a fixed dose of rivaroxaban is non-inferior to standard treatment
Commentary on: EINSTEIN-PE Investigators, Büller HR, Prins MH, Lensin AW, et al.. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012;366:1287–97. Context Pulmonary embolism (PE) is a common disease with potentially life-threatening consequences. Current guidelines1 recommend immediate start of anticoagulation with heparin for at least 5 days. Thereafter, heparin may be replaced by vitamin K antagonists (VKAs). The EINSTEIN-PE study tested rivaroxaban for the treatment of acute PE. Rivaroxaban, an oral anti-Xa antagonist, has the major advantage of oral administration wit...
Source: Evidence-Based Medicine - January 17, 2013 Category: Internal Medicine Authors: Niessner, A. Tags: Drugs: cardiovascular system, Stroke, Hypertension, Venous thromboembolism, Pulmonary embolism, Drugs: musculoskeletal and joint diseases Therapeutics Source Type: research
Metformin may not reduce cardiovascular risk or all-cause mortality
Commentary on: Boussageon R, Supper I, Bejan-Angoulvant T, et al.. Reappraisal of metformin efficacy in the treatment of Type 2 diabetes: a meta-analysis of randomised controlled trials. PLoS Med 2012;9:268–82. Context The treatment of hyperglycaemia is considered as one of the tools for preventing cardiovascular disease in Type 1 and Type 2 diabetic (T2D) patients.1 2 Metformin is recommended as the first-line drug for T2D by most international guidelines (IDF.2005. http://www.idf.org, 2007. http://www.aace.com, http://www.diabetesjournals.org, http://www.nice.org.uk/CG66). The preference for metformin over other av...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Monami, M. Tags: Geriatric medicine, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Diet, Ischaemic heart disease, Diabetes Online articles Source Type: research
Thrombolytic therapy with or without a vena cava filter results in a lower case fatality rate in unstable patients with acute pulmonary embolism
Commentary on: Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med 2012;125:465–70. Context Acute pulmonary embolism (PE) is a major health problem and is associated with significant morbidity and mortality. This is particularly true for patients with acute PE who are haemodynamically unstable.1 For instance, acute PE is associated with a 70% risk of death if cardiopulmonary arrest occurs and up to a 50% risk of death in those with shock secondary to PE.1 2 Several trials have evaluated the prognostic impact of thrombolytic therapy compared w...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Mean, M., Ibrahim, S. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Venous thromboembolism, Radiology, Pulmonary embolism, Clinical diagnostic tests Online articles Source Type: research
Tranexamic acid reduces blood transfusion in surgical patients while its effects on thromboembolic events and mortality are uncertain
Commentary on: Ker K, Edwards P, Perel P, et al.. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012;344:e3054. Context Surgical trauma leads to the activation of local fibrinolysis, and surgical bleeding can be significant in certain types of surgery leading to acute anaemia and the need for blood transfusion. Clinical trends have led to reductions in acceptable haemoglobin transfusion thresholds. However, growing evidence from clinical and experimental studies suggests that acute haemodilutional anaemia may reduce tissue oxygen delivery and increase perioperative morb...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Raveendran, R., Wong, J. Tags: Clinical trials (epidemiology), Epidemiologic studies, Haematology (incl blood transfusion), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism Therapeutics Source Type: research
