Add Aggrenox? Here we go again. ESPRIT

Lancet 5/20 – With the growing number of anti-thrombotic drugs, there seems to be a lack of consensus on exactly what anti-thrombotic regimen is to be used after major ischemic events such as stroke.

This weeks Lancet presents information from the ESPRIT trial – the latest study into the value of dipyridamole for treatment after CVA. The study was an RCT which assigned patients who experienced TIA / stroke within the previous 6 months to aspirin + dipyridamole vs aspirin alone.

In the end, the hazard ratio for major ischemic events was 0.81 in an intention to treat analysis. So the addition of dipyridamole to aspirin after an ischemic CVA lowered the risk of a  subsequent major ischemic event by about 20%. In addition the combination group had less (HR 0.67) bleeding complications. Unfortunately, about three times as many patients in the combo group dropped out, mostly due to headache. The effect was robust enough to be significant in an ITT analysis despite the high dropout rate.

Now if I could just get this whole Clodoprigel thing figured out….

Hiatus

sorry for the short hiatus – Graduation throws a wrench in the schedule. Maybe having those two new letters after my name will give my blog a much needed credibility boost.

Corticosteroids and Atrial Fibrillation

Archives IM 5/9 – van der Hooft et al. investigate the theory, based mostly on case reports, that high-dose pulse steroid are associated with in an increased risk of Atrial-fibrillation (AF).

The study was a case-control design, with patient data from the Rotterdam Study. Subjects were categorized as receiving either high dose or low/moderate dose steroids.
The odds ratio for developing new onset AF with 1 month of starting therapy was 6.07 compared to controls, whereas the odds from the low/moderate dose group was not significantly different.

The risk was independent of indication, which is reassuring. However, I wonder whether the use of high-dose steroids indicates a greater severity of disease which may be correlated with a generally increased risk of cardiac complications?

actually practical research

BMJ – Common advice to the post-surgical patient is to avoid getting the suture site wet for 24-48 hours. But is there any evidence to support it?

Heal et al. present a study in the BMJ investigating whether such advice is warranted. The study was done in Queensland, Australia – the last place you would really want a thick roll of gauze to cover anything in the summer heat. They find that there was no significant increase in surgical site infection if the suture line is exposed to water within 48 hours.

Responding physicians bring up the fact that this may contribute to the spread of disease in developing countries in which HBV infection is endemic.

Male contraception

Lancet – Liu et al in an article on male contraception – "Hormonal methods for safe, reliable, and reversible contraception based on the suppression of spermatogenesis could soon become available. We have investigated the rate, extent, and predictors of reversibility of hormonal male contraception."