Plenty of interesting research published this week and reviewed in the BMJ:
Aspirin Prevents Recurrent Venous Thromboembolism (N Eng J Med 2012; doi:10.1056/NEJMoa1210384) - At the moment gold standard treatment following VTE involves oral anticoagulation with warfarin after which treatment is either stopped altogether, or continued with increased risk of bleeding. Now research has been published which shows that long term treatment with aspirin may be good alternative to stopping altogether. Aspirin was shown in a placebo controlled trial to reduce the risk of major cardiovascular events in this group of patients although it did not significantly reduce the rate of VTE recurrence. Aspirin is cheap, easy to take, does not require monitoring and has a reasonable safety profile.
CABG not PCI for Adults with Diabetes (N Eng J Med 2012; doi:10.1056/NEJMoa1211585) - A newly published trial compared CABG vs. PCI in patients with diabetes and multivessel coronary artery disease and found that those treated with CABG lived significantly longer and had significantly fewer MIs than those treated with drug eluting stents. PCI has rapidly overtaken CABG as the most commonly used treatment for multi-vessel disease in the UK due to its increased affordability and availability, however this research may suggest that in patients with diabetes, CABG is still the gold-standard treatment and results in better outcomes.
Is Fasting Necessary before Lipid Tests? (Arch Intern Med 2012; doi:10.1001/archinternmed.2012.3708) - I recently asked a patient to attend the dermatology department for fasting lipids and this article caught my attention. Fasting overnight is inconvenient for the patient and unpleasant. A cross-sectional analysis of 209,180 results from Canada shows that overnight fasting makes little difference to total cholesterol and HDL cholesterol. The study adds to evidence that fasting may not offer any benefit for the patient or doctor in terms of predicting risk of cardiovascular disease.
And finally...interesting fact for the day - in pregnancy, 80% of DVTs occur in the left leg. Why? Well the reason for this is that pregnancy is a hypercoagulable state and this is exacerbated by venous stasis. This occurs when the gravid uterus obstructs the IVC, causing decreased venous tone in the legs, which is greater in the left leg than in the right.
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