Research of the week
Warfarin or aspirin for AF?
Age & Aging 2007; 36(2): 151–6
I had just about got my head around the idea that all patients with AF should be anticoagulated. Then I saw this article and feared my faith would be shaken again.
So it is with relief that I report that this work has shown the risk of adverse event is far greater with aspirin than warfarin. Of those patients taking aspirin, 33 per cent suffered adverse events with two of them dying.
This compared with 6 per cent of those using warfarin with one death recorded (the study population was 75, with 39 patients taking aspirin and 36 taking warfarin).
I was particularly struck by the figure that 9 per cent of octogenarians are in permanent AF, with AF accounting for 24 per cent of the stroke risk in this age group.
So it seems that all that trouble taken to monitor INRs is worthwhile.
Ovarian cancer, medical visits and pelvic examinations
CMAJ March 27, 2007; 176 (7). doi: 10.1503/cmaj.060697
Ovarian cancer is the second most common gynaecological cancer in North America and the leading cause of death among women with gynaecological cancer. Studies have been done to test efficacy of ultrasonography and cancer antigen 125 but the results have been such that even the American College of Obstetricians and Gynaecologists has not advocated their use for early detection.
This study set out to determine whether physician consultation and pelvic examination could do any better. It was a good-sized study with 668 cases and 721 age-matched controls. Cases were less likely than controls to report at least one medical visit per year (71.0 per cent versus 76.3 per cent) or at least one pelvic exam per year (67.7 per cent versus 74.5 per cent). There was no difference at all between the proportion of cases and controls who chose an obstetrician-gynaecologist as their regular care provider.
Those long-chain n-3 fatty acids
Lancet 2007; 369: 1,090–8
A study in Japan has shown that the addition of eicosapentaenoic acid (EPA) to statins helps reduce cholesterol levels further than a statin alone. It appears to have been a good trial with 18,645 patients followed over a five-year period and it showed benefit, with 2.8 per cent of the treatment group reaching the endpoint compared with 3.5 per cent of the statin-only group.
The question is whether it will work for our non-Japanese patients.
BMJ 2007; 334: 693–5
It is 5:50pm and the lab rings in with a high potassium level. Your heart sinks as you prepare to sort things out knowing in all probability it is yet another ‘hoax’. This paper, by a consultant in chemical pathology, is helpful in teasing out those cases about which you need to be concerned. It gives useful pointers like stating that true hyperkalaemia is rare in the presence of normal renal function but can be a consequence of thrombocytosis.
Confusion over PSA tests
BJGP 2007; 57: 303–10
This research was set up to ‘explore the experiences, understanding and views of men who considered or undertook PSA testing’. They might just as well have done the research among GPs because a fair bit of confusion reigns there as well. All of us will have had the experience of doing a PSA, perhaps at the patient’s request, only to find it raised and have the patient ‘go through the mill’.
What the researchers found was a good deal of uncertainty about having the test and about the results (even normal ones). Most men obtained their information from their extended social networks and the media. The researchers encourage doctors to be more ‘patient-centred’ in our consultation style.
More statins effects
JAMA 2007; 297: 1,344–53
The METEOR trial. Heard of it? No nor had I, but if you follow its advice your statin bills really will be through the roof, and for rather limited value. The question was whether taking rosuvastatin could slow progression or even cause regression of carotid intima-media thickening in middle-aged patients with a low Framingham risk score and mild-to-moderate sub-clinical atherosclerosis. The answer was ‘yes, maybe, a little bit’.
Over the two-year trial, there was a reduction in the rate of progression of atherosclerotic development, but no disease regression. Not worth it you might say, but I know of a number of doctors in their forties self-administering just in case.
Dr Holliday is a GP in Eton, Berkshire and a member of our team of GP research reviewers