June 4th, 2009 by Jerome Ecker, M.D. in Better Health Network, Health Tips
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Aspirin? – Yes, I should take that to prevent heart attack and stroke, right??
Well……perhaps. A new study (called a meta-analysis), the largest comparative trial of its kind, shows that being overzealous about aspirin use for prevention of initial heart attack and stroke may be unsubstantiated.
Specifically 95,000 subjects were evaluated, producing 1671 vascular events in the aspirin group and 1883 in the control group. Aspirin was associated with an absolute reduction of 0.06% heart-related events per year. Correspondingly, aspirin did not significantly reduce ischemic stroke risk, but researchers noted a borderline-significant increase in hemorrhagic stroke. Aspirin also increased the incidence of bleeding outside the brain. Overall, aspirin was not associated with a significant reduction in vascular death.
What does it mean? The advantages of aspirin in low risk patients are scant. As cardiovascular risk factors (like smoking, high cholesterol, high blood pressure, diabetes, family history of early stroke/heart attack) pile up, aspirin gains a bit more support, though there is a modest associated bleeding risk.
We will be following this data and it’s analysis further. In the meantime, it may be reasonable to discuss things with your doctor, or perhaps cut aspirin dosing to the appropriate lowest dose (81mg in most patients).
Want the original?
See Collins R et al. for the Antithrombotic Trialists’ (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009 May 30; 373:1849. We will post the appropriate links after publication to make it easier.
*This blog post was originally published at eDocAmerica*
April 18th, 2009 by CodeBlog in Better Health Network
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This story was related to me from a coworker:
I was taking care of a man who was on bipap. (Bipap is a form fitting mask that goes over the mouth and nose to help augment breathing. It has successfully been used numerous times in place of intubating patients and putting them on ventilators.) He was becoming restless and tired of the mask. I had to wait for the doctor to come and see him, though, before I could remove it.
Due to his medical condition, it was very important that he get an aspirin that day. Since I couldn’t give it to him by mouth (because of the mask), I had to explain to him that I’d need to give it rectally as a suppository.
He nodded his consent and I proceeded to give the aspirin.
A short while later, the doctor came to see the patient and agreed that we could take the bipap mask off for awhile. I happily entered the patients room to take the mask off… and before it was even off his face, he stuck his finger in the air and said,
“FOR THE RECORD, that is a hell of a way to take an aspirin!!”
It’s a hell of a way to give one, too.
*This blog post was originally published at Gina Rybolt, RN’s Code Blog.*
October 17th, 2008 by Dr. Val Jones in Patient Interviews
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Deanna and Rebecca Sherman
As many as 15% of Americans have a blood disorder (called anti-phospholipid antibody syndrome - APS) that can increase their risk for blood clots and stroke. While these antibodies are especially common in people with certain auto-immune diseases like SLE (systemic lupus erethematosis – or “lupus”) quite a few people have them without ever knowing it. In fact, most people with APS remain asymptomatic their entire lives – but for an unlucky few, the disorder can cause devastating consequences.
I interviewed Rebecca Sherman about her recent stroke caused by APS. Listen to the podcast here.
Dr. Val: Tell me about the events leading up to your stroke.
Sherman: I was a young, healthy 32-year-old with no idea that I had anti-phospholipid antibodies in my blood. One morning when I was washing my face at my boyfriend’s house I suddenly noticed that one side of it was frozen. I was standing in front of the bathroom sink and I fell to the floor with the washcloth in my hand. I couldn’t walk or talk – the whole right side of my body didn’t do what I wanted it to do. So I threw the washcloth at my boyfriend’s head (with my left hand). Luckily my aim was good (he was asleep in bed) and the bed was near the door to the bathroom - the cold, wet object caused him to jump out of bed and find me. Read more »
