I think an unfortunate result of the ACC meetings is the feeling that if a study is not released early and does not make the front page of the New York Times then it is not relevant or worth talking about. We’ll save the debate about releasing results early for another time (although it frequently seems to be a self-serving public relations move by the journal publishing the article) …let’s march forward with several articles that were released this week with little fanfare.
In this week’s Lancet is an open label multi-national trial comparing enoxaparin to unfractionated heparin after an ischemic stroke to prevent venous thromboembolism. Although industry sponsored the number needed to treat (NNT) using enoxaparin was 13 to prevent an episode of venous thromboembolism. The number needed to harm from clinically important bleeding was 173. Seems to be yet another nail in the coffin for unfractionated heparin.
Lancet Link: http://sfx.med.nyu.edu/sfxlcl3?genre=article&id=pmid:17448820&_char_set=utf8
The American Heart Association released guidelines on the prevention of infective endocarditis. The guidelines discourage the use of antibiotic prophylaxis for dental procedures recommending them only for patients with prosthetic cardiac valves, heart transplant recipients who develop cardiac valvulopathy, those who have previously had infective endocarditis, and some patients with congenital heart disease. No antibiotics are recommended for urologic or gastrointestinal procedures.
JAMA has an excellent article in their clinical crossroads series discussing acupuncture for knee osteoarthritis. The article nicely summarizes the current status of conventional and alternative treatments for degenerative joint disease.
Keeping along the lines of alternative medicine, the Annals has a meta-analysis which reviews 20 studies of chondroitin for osteoarthritis of the knee/hip. Their conclusion, similar to a recent study on glucosamine and chondroitin, is that chondroitin has minimal effect on joint pain and inconclusive effects on joint space.
Finally going back to last week’s JAMA, a double blind randomized multicenter study randomized 141 patients undergoing cabg, aortic valve replacement or both to placebo or hydrocortisone. Giving steroids resulted in a NNT of 6 to prevent 1 epiosde of atrial fibrillation without higher rates of wound infections or other complications.
Neil Shapiro, MD Editor-In-Chief, Clinical Correlations
Image Courtesy of Ranata Szar, Warsaw, Poland-stock.xchng.hu