Patient Care Neurology & Psychiatry - November 2007 - (Page 26)

ClinicalClips JOHN J. RUSSELL, MD, Contributing Editor Associate Director, Family Medicine Residency, Abington Memorial Hospital, Abington, Pa. Dr Russell and colleagues abstract current reports and studies from evidence-based medical literature and provide commentary relevant to primary care. I Stroke prevention: Warfarin or aspirin? Mant J, Hobbs FD, Fletcher K, et al; BAFTA investigators; Midland Research Practices Network (MidReC). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370(9586):493-503. group and 1 patient to the aspirin group. The authors believe these data strongly support the use of warfarin in patients older than 75 with AF and that age should not be a contraindication to this therapy. Jeff Kirchner, DO Lancaster General Hospital, Lancaster, Pa. Atrial fibrillation (AF) affects 12% of persons older than 75 and is a major risk factor for stroke. Previous studies have shown that anticoagulation with warfarin is superior to aspirin for preventing stroke in AF but results in greater expense due to monitoring and also increases the risk of bleeding. This trial from the United Kingdom compared these 2 agents in elderly patients with documented AF A total of 973 patients aged 75 and older . (mean age 81) were randomized to receive aspirin, 75 mg/d, or warfarin. The primary clinical end points were fatal or disabling stroke, arterial embolism, and intracranial hemorrhage. Impact for clinicians After a mean follow-up of approximately 3 years, there were 21 strokes in the warfarin group compared to 44 in the aspirin group. Of the patients taking aspirin, 3 had a systemic embolism, while only 1 patient taking warfarin experienced this. An intracranial bleed was sustained by 2 patients assigned to the warfarin Clinical Clips is adapted from Clinical Update, which is formatted for Palm OS devices and delivered electronically. Contact the publisher at http://www.redi-reference.com/ beweek.htm for information on how to subscribe. I Antidiabetic drugs for patients with diabetes and heart failure Eurich DT, McAlister FA, Blackburn DF, et al. Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review. BMJ. 2007;335(7618):497. The role of antidiabetic drugs in managing diabetes in patients with heart failure is uncertain, and controversy exists about their effect on outcomes (admission to hospital and death). A systematic review and meta-analysis of controlled studies in this patient population sought to clarify the situation. Impact for clinicians Insulin showed an increased risk for all-cause mortality. Metformin was associated with significantly reduced all-cause mortality and was not associated with increased hospital admission for any cause or for heart failure specifically. Use of thiazolidinediones was associated with reduced all-cause mortality but an increased risk of hospital admission for heart failure. The 2 studies of sulfonylureas had conflicting results, probably because of differences in comparator treatments. S. Scott Paist, MD Lancaster General Hospital, Lancaster, Pa. Clinical Clips Panel Jonathan D. Beck, MD Christopher V. Chambers, MD Jeff Kirchner, DO Matthew Mintz, MD David Nicklin, MD S. Scott Paist, MD Charles A. Pohl, MD 26 PATIENT CARE NEUROLOGY & PSYCHIATRY www.patientcareonline.com http://www.redi-reference.com/ http://www.patientcareonline.com

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Patient Care Neurology & Psychiatry - November 2007 Contents Research Digest Medicine in the News The 15-Minute Visit Dementia workup and treatment: Do the drugs really work? Help for Your Patients Who Suffer from Specific Phobias Clinical Clips Case & Comment The Science of Healing Classified Advertising

Patient Care Neurology & Psychiatry - November 2007

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