Warfarin Interactions With Antibiotics
Warfarin Interactions With Antibiotics in the Ambulatory Care Setting [JAMA Intern Med. 2014]
A retrospective, longitudinal cohort study evaluated patients receiving warfarin between January 1, 2005, and March 31, 2011, at Kaiser Permanente Colorado.
CONCLUSIONS AND RELEVANCE
Acute upper respiratory tract infection increases the risk of excessive anticoagulation independent of antibiotic use.
Antibiotics also increase the risk; however, most patients with previously stable warfarin therapy will not experience clinically relevant increases in INR following antibiotic exposure or acute upper respiratory tract infection.
Read MoreNew Lipid Guidelines – Hooray!
This week, the American College of Cardiology and American Heart Association (ACC/AHA) released new guidelines for the management of Lipids.
The new guidelines are a major shift in thinking. They are far closer to the proposed POQ in the discussion elsewhere on this site than to the previous guidelines. Spooky. This is clearly cause and effect. Who would have thought we had that much influence?
Key points in new guidelines.
Treating to LDL cholesterol targets is no longer recommended.
Patients should receive Statins if they fall into one of these four groups.
- Patients with clinical atherosclerotic cardiovascular disease (ASCVD) should receive high-intensity (age, <75) or moderate-intensity (age, ≥75) statin therapy.
- Patients with LDL cholesterol levels ≥ 4.9 mmol/L should receive high-intensity statin therapy.
- Diabetic patients aged 40–75 with LDL cholesterol levels of 1.8–4.9 mmol/L and without clinical ASCVD should receive at least moderate-intensity statin therapy (and possibly high-intensity statin therapy when estimated 10-year ASCVD risk is ≥7.5%).
- Patients without clinical ASCVD or diabetes but with LDL cholesterol levels of 1.8-4.9 mg/dL and estimated 10-year ASCVD risk ≥7.5% should receive moderate- or high-intensity statin therapy.
High-intensity statin therapies are atorvastatin (40–80 mg) or rosuvastatin (Crestor; 20–40 mg). Moderate-intensity statin therapies include atorvastatin (10–20 mg), rosuvastatin (5–10 mg), simvastatin (20–40 mg), pravastatin (40–80 mg), and several others.
With few exceptions, use of lipid-modifying drugs other than statins is discouraged.
Lifestyle modification is recommended for all patients, regardless of cholesterol-lowering drug therapy.
These guidelines use a new ten year risk calculator which includes both coronary events and stroke, and is only available as an Excel spreadsheet currently.
This is different to the calculators used in Australia, as per another discussion on this site.
Join the discussion as we prepare our POQ at this forum
Read MoreACE Inhibitors best for hypertension in diabetes
Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis | BMJ
Hon-Yen Wu et al
BMJ 2013;347:f6008
A meta-analysis of 63 trials with 36 917 participants, looking at survival and reno-protection, concluded that ACE inhibitors should be first line treatment in people with diabetes.
Read MoreConclusion:
Our analyses show the renoprotective effects and superiority of using ACE inhibitors in patients with diabetes, and available evidence is not able to show a better effect for ARBs compared with ACE inhibitors. Considering the cost of drugs, our findings support the use of ACE inhibitors as the first line antihypertensive agent in patients with diabetes. Calcium channel blockers might be the preferred treatment in combination with ACE inhibitors if adequate blood pressure control cannot be achieved by ACE inhibitors alone.
Top 20 POEMS for 2012
Mark Ebell is the editor of Essential Evidence Plus, a great source of POEMS, and to which I subscribe.
He has nominated the top POEMS of 2012. The list was published in The American Family Physician last November.
Top 20 research studies of 2012 for primary care physicians
Ebell MH, Grad R.
Am Fam Physician 2013 Sep 15;88(6):380-6.
A subscription is required, but Australia Doctor has replicated the list at
20 studies every GP should read (how can they do that?)
No pain no gain – Exercise is good for pain in hip and knee osteoarthritis
Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis
Paul S. Mueller, MD, MPH, FACP Reviewing Uthman OA et al., BMJ 2013 Sep 20; 347:f5555
There is good evidence that we should be prescribing exercise for people with osteoarthritic pain in the hip and knee.
Read MoreConclusion:
An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis.
Effect of vitamin D supplemention on depression – none
Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial
Kjærgaard M, Waterloo K, Wang CE, Almås B, Figenschau Y, Hutchinson MS, Svartberg J, Jorde R.
Reference : Br J Psychiatry. 2012 Nov;201(5):360-8. doi: 10.1192/bjp.bp.111.104349. Epub 2012 Jul 12.
I guess you wouldn’t be surprised if people in Norway had lower levels of Vitamin D than people in sunnier climates.
In this RCT, people with lowish Vit D levels (less than 55 nmol/L) were more likely to be depressed. Perhaps the depressive symptoms made them more likely to stay inside.
After six months, supplementation did improve Vit D scores to ‘normal’, but had no significant affect on depression when compared with a placebo group. Happily, both placebo and treatment arms improved.
Read MoreConclusion:
“Low levels of serum 25(OH)D are associated with depressive symptoms, but no effect was found with vitamin D supplementation”