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Review of Articles that Might Alter Clinical Behavior -II

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-S1-002, Clinical Study
Received: July 29, 2015: Accepted: August 07, 2015: Published: August 14, 2015
Citation: Rothschild B (2015) Review of Articles that Might Alter Clinical Behavior -II. J Rheum Dis Treat S1:002
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.


NSAIDS and Bleeding

Relation of nonsteroidal anti-inflammatory drugs (NSAIDs) to serious bleeding and thromboembolism risk in patients with atrial fibrillation receiving antithrombotic therapy [1].

Population studied - 1997-2011 new atrial fibrillation in Denmark

NSAID dose - assumed utilized, even if not refilled.

    - estimated from prescription refills

Outcome measure of event within 14 days of a NSAID dose

    - serious bleeding within 14 days

    - thromboembolic stroke or systemic embolism

Result - 11.3% serious bleeding

     • 13% thromboembolic event

Admitted defects

     - failure to assess adequacy or overdose (INR) of anticoagulant

     - failure to control for smoking, body mass index
Interpretation:

• Effect of NSAIDs on bleeding and thromboembolic event rates in this study is uninterpretable without knowledge of anticoagulation quality

• Adequacy of anticoagulation monitoring should be of prime concern


Implication of this study for clinical practice

No alteration of clinical practice indicated on the basis of this study, based on the above flaws.


NSAIDS and Strokes


Preadmission use of nonaspirin nonsteroidal anti-inflammatory drugs and 30-day stroke mortality [2].

Population studied - Denmark - derived from same study as above

NSAID dose - used within 60 days of event

     - estimated from prescription refills

Outcome measure - ischemic stroke

Result - 0.15-2.37 adjusted deaths with celebrex

     - 0.62-1.30 for etodolac

     - 0.87-1.48 for diclofenac

     - 0.64-2.55 for naprosyn

Defects - neither controlled for smoking, NSAID indication, nor apparently for aspirin use.
Interpretation:

Uninterpretable because of failure to control for con-commitant aspirin use and for presence of anti-phospholipid syndrome


Implication of this Study for Clinical Practice

No alteration of clinical practice indicated on the basis of this study, based on the above defects.


References
  1. Lamberts M, Gregory Y.H. Lip, Morten Lock Hansen, Jesper Lindhardsen, Jonas Bjerring Olesen (2014) Relation of Nonsteroidal Anti-inflammatory Drugs to Serious Bleeding and Thromboembolism Risk in Patients With Atrial Fibrillation Receiving Antithrombotic Therapy: A Nationwide Cohort Study. Ann Intern Med 161: 690-702.

  2. Bola M, Gall C, Moewes C, Fedorov A, Hinrichs H, Sabel BA (2014) Brain functional connectivity network breakdown and restoration in blindness Neurology 83: 1-10.

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