{"id":42179,"date":"2014-03-17T15:22:03","date_gmt":"2014-03-17T19:22:03","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=42179"},"modified":"2014-03-17T15:22:03","modified_gmt":"2014-03-17T19:22:03","slug":"selections-from-richard-lehmans-literature-review-march-17th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/03\/17\/selections-from-richard-lehmans-literature-review-march-17th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: March 17th"},"content":{"rendered":"

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman\u2019s\u00a0weekly journal review blog<\/a>\u00a0at\u00a0BMJ.com<\/a>. Selected summaries are relevant to our audience, but we encourage members to engage with the\u00a0entire blog<\/a>.<\/em><\/p>\n

Lancet\u00a0 15 Mar 2014 Vol 383<\/strong><\/p>\n

Comparison of the Efficacy and Safety of New Oral Anticoagulants with Warfarin in Patients with AF (pg. 955):<\/strong>\u00a0 \u201cAnd God saw every thing that he had made, and, behold, it was very good.\u201d Gen 1.31. This meta analysis of new oral anticoagulants for atrial fibrillation breathes a similar air of contentment. They are, quite simply, better than warfarin, especially when INR control is suboptimal. In an overall comparison with warfari<\/a>n, they decrease all-cause mortality by about 10%, and reduce stroke and other embolic events by about 19%. What\u2019s not to like? Well, a bit more gastrointestinal bleeding and a lot more cost. So if you have AF and feel strongly, you should follow the advice of the director of NICE and march along to your GP and demand some dabigatran. Or apixaban. Or rivaroxaban. Or wait a bit, until edoxaban has been approved. Why should you worry about cost to the NHS? When did anyone ever ask you about how much the nation should spend on health, or fulfil an electoral promise about the NHS?<\/p>\n

Mortality from Ruptured Abdominal Aortic Aneurysms (pg. 963):<\/strong> It\u2019s blood-in-the-boots time again folks. In the UK, more than 90% of ruptured abdominal aortic aneurysms are repaired by open surgery, whereas in the USA, the figure is 79%. Over there, they offer surgery to a lot more people too: 80% of those with ruptured AAA as opposed to 58% here. Yet their in-hospital mortality is somewhat better than ours, at 53 versus 66%. So we must learn lessons from America<\/a>, but it isn\u2019t quite clear what these are. The main one seems to be to rush off people with rAAA to high volume centres.<\/p>\n

Metabolic Mediators of the Effects of BMI, Overweight, and Obesity on CHD and Stroke (pg. 970):<\/strong> As an aging man who likes food and doesn\u2019t get much time away from a desk, I puzzle about the importance of overweight. It seems to me that the main problem is the tightness of one\u2019s clothes. This is somewhat confirmed by this Lancet<\/em> analysis<\/a>, which concludes that \u201cInterventions that reduce high blood pressure, cholesterol, and glucose might address about half of excess risk of coronary heart disease and three-quarters of excess risk of stroke associated with high BMI. Maintenance of optimum bodyweight is needed for the full benefits.\u201d The last has to be true. Taking losartan and a statin has made no difference whatever to the tightness of my clothes.<\/p>\n

The Framingham Heart Study and the Epidemiology of Cardiovascular Disease (pg. 999):<\/strong> In a few weeks\u2019 time, all who can should visit Framingham, Mass. The Woodland Garden there will be full of the most wonderful erythroniums, trilliums, and sanguinarias. Others may wish to make the pilgrimage because it is 65 years since the first subjects were recruited to the Framingham Heart Study, marking the beginning of a new era in epidemiology. Here is a fascinating history of the project<\/a>, which was stimulated in part by F.D. Roosevelt\u2019s death from galloping hypertension. It\u2019s a wonderful reminder of how much good work could be done by means of messages written on rickety typewriters, simple paper charts, and card indexes. No internet for the first 40 years.<\/p>\n

BMJ\u00a0 15 Mar 2014\u00a0 Vol 348<\/strong><\/p>\n

Exclusion of DVT Using the Wells Rule in Clinically Important Subgroups:<\/strong> When faced with a possible deep vein thrombosis, I try to apply the Wells rules and do a d-dimer test, but I\u2019m constantly frustrated at how often they simply don\u2019t apply to the clinical situation. This individual patient data meta-analysis<\/a>, whose authors include the great Professor Wells himself, concludes that \u201cCombined with a negative D-dimer test result (both quantitative and qualitative), deep vein thrombosis can be excluded in patients with an unlikely score on the Wells rule. This finding is true for both sexes, as well as for patients presenting in primary and hospital care. In patients with cancer, the combination is neither safe nor efficient. For patients with suspected recurrent disease, one extra point should be added to the rule to enable a safe exclusion.\u201d Add to this pregnant women and elderly people with fragility bruises, and you find yourself giving a lot of LMW heparin until you can get a scan, just in case.<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include a comparison of the safety and efficacy of the new oral anticoagulants with warfarin in patients with AF, a study on mortality from ruptured abdominal aortic aneurysms, and more.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[1284,341,1585,2207,1154,2206,368],"class_list":["post-42179","post","type-post","status-publish","format-standard","hentry","category-general","tag-abdominal-aortic-aneurysm","tag-atrial-fibrillation","tag-deep-vein-thrombosis","tag-framingham-heart","tag-oral-anticoagulants","tag-ruptured-abdominal-aortic-aneurysms","tag-warfarin"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/42179","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/475"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=42179"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/42179\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=42179"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=42179"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=42179"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}