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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
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
Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances
We congratulate Alper et al for their reanalysis of the Third European Cooperative Acute Stroke Study.1 They found that after adjusting for baseline imbalances in history of prior stroke and stroke severity, there was no statistical benefit with alteplase, but the harms were reconfirmed. So, the difference in outcome could be fully explained by the baseline imbalance. It is worth remembering that a clinical trial has internal validity if and only if the imbalance between groups, bias in the assessment of outcome, and chance have been excluded as possible explanations for the difference in outcomes. It also reaffirms the fr...
Source: Evidence-Based Medicine - November 25, 2021 Category: Internal Medicine Authors: Fatovich, D. M., Milne, W. K. Tags: Letters Source Type: research
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
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
Stroke rates vary substantially across cohorts of patients with atrial fibrillation
Commentary on: Quinn GRSeverdija ONChang Y. Wide variation in reported rates of stroke across cohorts of patients with atrial fibrillation. Circulation 2017;135:208–19. Context Oral anticoagulants (OACs) substantially reduce stroke risk in patients with atrial fibrillation (AF); however, they remain globally underused.1 One of the main reasons is the difficulty in stratifying AF-related ischaemic stroke risk at the individual patient level.1 2 Among scores stratifying AF-related stroke risk, CHA2-DS2-Vasc prevails in most recent international AF guidelines.3 4 Still, it remains unknown whether AF-related stroke risk ...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Sposato, L. A., Saposnik, G. Tags: EBM Prognosis Source Type: research
Decompressive craniectomy for severe traumatic brain injury reduces mortality but increases survival with severe disability
Commentary on: Hutchinson PJ, Kolias AG, Timofeev IS, et al.. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. N Engl J Med 2016;375:1119–30. Context There is little doubt that decompressive craniectomy can reduce mortality in traumatic brain injury; this was clearly demonstrated by previous trials investigating the efficacy of decompressive hemicraniectomy following ischaemic stroke.1 However, surgical decompression will not reverse the effects of the pathology that precipitated the neurological crisis and the concern has always been that the reduction in mortality comes at the cost of an ...
Source: Evidence-Based Medicine - March 23, 2017 Category: Internal Medicine Authors: Honeybul, S. Tags: 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
Pitfalls of administrative database analysis are evident when assessing the 'weekend effect in stroke
Commentary on: Li L, Rothwell PM. Biases in detection of apparent "weekend effect" on outcome with administrative coding data: population based study of stroke. BMJ 2016;353:i2648 . Context Multiple studies attempt to clarify the role of weekend admissions in stroke.1 2 Recent studies have leveraged large populations in administrative databases to retrospectively evaluate hypotheses. While these studies disagree as to whether weekend admissions are associated with increased stroke mortality, concern exists regarding inherent limitations of administrative coding databases, including accuracy of patient and disease variables...
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Attenello, F. J., Mack, W. J. Tags: EBM Prognosis, Journalology, Epidemiologic studies, Stroke 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
Existing evidence is insufficient to justify metformin or other agents as first-line therapy for type 2 diabetes
Commentary on: Palmer SC, Mavridis D, Nicolucci A, et al.. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: a meta-analysis. JAMA 2016;316:313–324 . Context A broad consensus supports the use of metformin as first-line therapy for patients with type 2 diabetes. Clinicians and patients, however, may be interested in using newer antihyperglycaemic drugs as first-line treatment, but their relative advantages to metformin—beyond burden of treatment and hypoglycaemic potential—remain uncertain. The systematic review by Palmer et al soug...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Rodriguez-Gutierrez, R., Montori, V. M. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Therapeutics/Prevention Source Type: research
Aspirin reduces cardiovascular events in primary prevention of cardiovascular disease but at a near equivalent risk of increased bleeding
Commentary on: Guirguis-Blake JM, Evans CV, Senger CA, et al.. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the US Preventive Services Task Force. Ann Intern Med 2016;164:804–13 . Context The use of aspirin in primary prevention of cardiovascular disease (CVD) remains controversial, as randomised controlled trials (RCTs) have produced mixed results. Recently, the United States Preventive Services Task Force (USPSTF) published updated recommendations on the use of aspirin for primary prevention of CVD and colorectal cancer.1 This systematic review and meta-analysis serv...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Miedema, M. D., Virani, S. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease Therapeutics/Prevention Source Type: research
In individuals at intermediate risk for cardiovascular disease, treatment with rosuvastatin but not candesartan plus hydrochlorothiazide lowers cardiovascular disease event rates
Commentary on: Lonn EM, Bosch J, López-Jaramillo P, et al.. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:2009–20 . Yusuf S, Bosch J, Dagenais G, et al. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:2021–31. Context Cardiovascular diseases (CVD) are the number one cause of death globally: more people die annually from CVDs than from any other cause.1 The incidence of CVD rises progressively with increasing blood pressure (BP) and with increasing levels of total and low density lipoprotei...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: LeFevre, M. Tags: Drugs: cardiovascular system, Pain (neurology), Stroke, Hypertension, Ischaemic heart disease Therapeutics/Prevention Source Type: research
Low-dose second-generation oral contraceptives are associated with the lowest increased risk of cardiovascular adverse effects
Commentary on: Weill A, Dalichampt M, Raguideau F, et al.. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ 2016;353:i2002 . Context Oral contraceptives (OCs) are associated with an increased risk of cardiovascular disease. The association varies depending on whether the cardiovascular disease is arterial or venous and with varying progestogens and dosages of the oestrogen compound ethinyloestradiol. A recent Cochrane review concluded that OCs with the progestogens gestodene, desogestrel, cyproterone acetate or d...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Lokkegaard, E. Tags: Health policy, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Contraception, Drugs: obstetrics and gynaecology, Pregnancy, Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism Aetiology/Harm Source Type: research
Morphine exposure in preterm infants correlates with impaired cerebellar growth and poorer neurodevelopmental outcome
This study included 136 infants born at 24–32 weeks gestational age who underwent magnetic resonance imaging of the brain near birth and...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: McPherson, C. Tags: Clinical trials (epidemiology), Epidemiologic studies, Pain (neurology), Stroke, Pain (palliative care), Radiology, Drugs: musculoskeletal and joint diseases, Clinical diagnostic tests, Radiology (diagnostics) Aetiology/Harm Source Type: research
Cognitive adverse effects and brain deterioration associated with use of anticholinergic activity medicines in older adults
This study examined whether medicines with anticholinergic activity alter brain glucose metabolism, and the impact this has on brain structure, function and cognitive decline. Methods This retrospective cohort study involved 402 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) centre and 49 participants from the Indiana Memory and Aging Study (IMAS). Data on cognitive and neuroimaging findings...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Nishtala, P. S., Salahudeen, M. S. Tags: Geriatric medicine, Epidemiologic studies, Dementia, Drugs: CNS (not psychiatric), Sleep disorders (neurology), Stroke, Memory disorders (psychiatry), Psychiatry of old age, Sleep disorders, Sleep disorders (respiratory medicine) Aetiology/Harm Source Type: research
