Journals watch: Anticoagulants, emergency contraception and prostate cancer

Dr Louise Newson reviews the latest research on anticoagulants, emergency contraception and prostate cancer

Prostate cancer: about one in four patients will try CAM therapy

Complementary medicine in prostate and bladder cancer

BJU Int 2013; 112: 1073-9

It has been estimated that about one in four patients with prostate cancer will try at least one complementary and alternative medicine (CAM) method.

However, a significant proportion of these patients (up to 77%) do not disclose this to their doctor.

This paper provides an overview of the scientific and clinical studies underlying common vitamin and herbal preparations used in prostate and bladder cancer.

Although some initial clinical studies investigating the chemotherapeutic properties of pomegranate and green tea in prostate and bladder cancer have shown encouraging results, there is still no good conclusive evidence for the use of CAM in prostate and bladder cancer.

Dabigatran and warfarin in patients with a major bleed

Circulation 2013; 128: 2325-32

Although novel oral anticoagulants (NOACs) seem attractive as no monitoring is required, there is a concern over their long-term safety and, perhaps more importantly, there are no antidotes for these drugs.

This study compared the management of major bleeding in patients taking dabigatran or warfarin. Reports were investigated from more than 1,000 patients with major bleeds who had been taking dabigatran or warfarin for six to 36 months.

Patients with major bleeds on dabigatran were older, had lower creatinine clearance, and more frequently used aspirin or NSAIDs than those on warfarin.

However, patients who had major bleeding on dabigatran required more red cell transfusions but received less plasma, required a shorter stay in intensive care and had a trend to lower mortality compared with those on warfarin.

Effect of teenage motherhood on cognitive outcomes in children

Arch Dis Child 2013; 98: 959-64

This study examined the association between teenage motherhood and cognitive development at five years using data from the Millennium Cohort Study, a prospective, nationally representative UK cohort of 18,818 infants born in 2000-01.

The researchers found that about one in 20 children were born to mothers aged 18 years or less.

Their analysis revealed that children of teenage mothers had significantly lower cognitive scores compared with children of mothers aged 25-34 years.

After adjustment for perinatal and sociodemographic factors, the effect of young maternal age on non-verbal and spatial ability mean scores was attenuated, but there was a difference in mean verbal ability scores, equivalent to an average delay of five months.

Emergency contraception following new guidelines

J Fam Plann Reprod Health Care 2013; 39: 264-9

This study looked at the use of emergency contraception and the choices offered in a sexual and reproductive healthcare service in Liverpool before and after UK Faculty of Sexual and Reproductive Healthcare (FSRH) guidelines were adopted.

The use of levonorgestrel (LNG) fell from 93% to 76% and the use of ulipristal (UPA) rose from 3% to nearly 19%.

In the second three-month period, of the women offered all three methods, 54.9% chose LNG and 39.8%, UPA. Although women were given the choice, a large proportion still chose LNG.

Antiplatelet therapy and PPIs

Br J Cardiol 2013; 20: 4

Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is recommended for up to one year following acute coronary syndrome (ACS).

The main purpose of this study was to analyse the effect of PPIs (lansoprazole, pantoprazole and omeprazole) in reducing the subsequent risk of GI bleeding.

The study found that empirical prophylactic prescription of PPIs for patients on DAT following ACS is of no significant benefit in reducing their predisposition to upper GI bleeding.

There was no statistically significant difference in GI bleeding between the two groups. The authors conclude that only patients with an increased risk of GI bleeding should be considered for PPIs.

  • Dr Newson is a GP in the West Midlands and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Hold a meeting with a local cardiologist to discuss the pros and cons of prescribing NOACs.
  • Discuss ways of improving support for teenage mothers with your health visitors and other healthcare professionals.
  • Obtain a copy of the most recent FSRH guidelines on emergency contraception and familiarise yourself with them.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

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