{"id":48111,"date":"2015-05-07T15:52:45","date_gmt":"2015-05-07T19:52:45","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=48111"},"modified":"2015-05-15T18:10:51","modified_gmt":"2015-05-15T22:10:51","slug":"selections-from-richard-lehmans-literature-review-may-5th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2015\/05\/07\/selections-from-richard-lehmans-literature-review-may-5th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: May 7th"},"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

JAMA<\/em> 28 April 2015 Vol 313<\/strong><\/p>\n

Effect of a Retrievable Inferior Vena Cava Filter Plus Anticoagulation vs Anticoagulation Alone on Risk of Recurrent Pulmonary Embolism (pg. 1627):<\/strong> About 30 years ago, one of my patients returned from the US with a filter in his inferior vena cava, having had a very expensive pulmonary embolus in the land of the free. This procedure has never caught on in the NHS, and a good thing too. But it persists across the Atlantic, despite many trials proving its lack of effect. The latest shows that \u201cAmong hospitalized patients with severe acute pulmonary embolis<\/a>m, the use of a retrievable inferior vena cava filter plus anticoagulation compared with anticoagulation alone did not reduce the risk of symptomatic recurrent pulmonary embolism at 3 months.\u201d<\/p>\n

Ann Intern Med<\/em> 21 April 2015 Vol 162<\/strong><\/p>\n

Cost-Effectiveness and Population Impact of Statins for Primary Prevention in Adults Aged 75 Years or Older in the United States (pg. 533):\u00a0<\/strong> Last year I had several tries at writing a short critique of the\u00a0National Institute for Health and Care Excellence guideline on statins, but in the end I had such a severe hemiplegic migraine that I decided that I might die in the attempt. Fortunately, others have risen to the challenge, and I hope that continuing debate about this issue will mark a turning point in our conceptualisation of population risk and how to make decisions with individuals. One of the most extraordinary recommendations was to offer all people over the age of 85 a statin because of their 10+% risk of a cardiovascular event. In this paper, an attempt is made to predict the cost effectiveness of statin treatment<\/a> of all American adults aged 75 to 94 years using Markov modelling. Do access it if you are interested, but to me it just proves how inadequate the data are to support such modelling, even if it was legitimate to apply it . . . But don\u2019t get me started. I can feel a migraine coming on.<\/p>\n

The BMJ<\/em> 2 May 2015 Vol 350<\/strong><\/p>\n

Risk of GI Bleeding Associated with Oral Anticoagulants:<\/strong> Stents, mabs, and NOACs. They\u2019ve dominated the journals these last 17 years, and I hope you haven\u2019t grown as weary trying to follow them as I have trying to write about them. NOACs are novel oral anticoagulants. Throughout the 2000s, they started pouring from the drug companies.\u00a0These exciting drugs promised an end to the need for warfarin and blood testing. One week it would be apixaban for atrial fibrillation. The next week it might be dabigatran for VTE. As they proliferated, and one began to multiply all the drugs by all the indications by all the comparisons, it seemed that the line might stretch to th\u2019 crack of doom. One began to lose the will to read, if not to live. This week\u2019s BMJ<\/em> attempts a reality check in the form of two American papers comparing dabigatran v rivaroxaban v warfarin <\/a>for all indications in relation to the risk of gastrointestinal bleeding<\/a>. They are much of a muchness, within wide confidence intervals.<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics are a comparison of a retrievable inferior vena cava filter plus anticoagulation vs. anticogulation alone for recurrent PE, the cost effectiveness and population impact of statins for primary prevention in U.S. adults age 75 and older, and more.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[492,818,1539,2464,596,2559,584],"class_list":["post-48111","post","type-post","status-publish","format-standard","hentry","category-general","tag-anticoagulation","tag-elderly","tag-gastrointestinal-bleeding","tag-new-oral-anticoagulants","tag-pulmonary-embolism","tag-retrievable-inferior-vena-cava-filter","tag-statins"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/48111","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=48111"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/48111\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=48111"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=48111"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=48111"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}