Review of Articles that Might Alter Clinical Behavior - I
Bruce Rothschild*
Department of Medicine, Northeast Ohio Medical University, USA
*Corresponding author:
Bruce Rothschild, Department of Medicine, Northeast Ohio Medical University, USA, E-mail: spondylair@gmail.com
J Rheum Dis Treat,
JRDT-S1-001,
Clinical Study
Received: July 29, 2015: Accepted: August 13, 2015: Published: August 17, 2015
Citation: Rothschild B (2015) Review of Articles that Might Alter Clinical Behavior - I. J Rheum Dis Treat S1:001
Copyright: © 2015 Rothschild B. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Articles assessed for general validity & for applicability to the population we serve.
Just when you thought it was safe to go in the water.
A randomized controlled trial of ibuprofen, paracetamol or a combination tablet of ibuprofen/paracetamol in community-derived people with knee pain [1].
Population studied - 892 English patients with knee pain.
Medication comparisons
• ibuprofen - 400mg tid
• acetaminophen (Tylenol) 1000 tid
• ibuprofen (I) + acetaminophen (A) tid
- 200mg I + 500mg A
- 400mg I + 1000mg A
Outcome measure - hemoglobin decrease >1g/dl
Result
• ibuprofen - 19.6%
• acetaminophen (Tylenol) - 20.3%
• ibuprofen + acetaminophen tid
- 200mg I + 500mg A - 24.1%
- 400mg I + 1000mg A - 38.4%
Interpretation:
Acetaminophen at doses of 3000 mg/day may have greater gastrointestinal toxicity than previously recognized.
Co-ingestion of acetaminophen and ibuprofen [even at the very low dose of 1200 mg/day (contrasted with anti-inflammatory doses of 3600mg/day)] significantly increases blood loss.
Implication of this Study for Clinical Practice
Acetaminophen is so commonly used that avoidance of ibuprofen seems appropriate, not just because it is less safe to co-ingest, but also because ibuprofen (specifically among the NSAIDs) blocks the cardioprotective effect of aspirin.
References
