Minerva medica
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Review Meta Analysis
Aspirin for the prevention of cardiovascular morbidity.
Aspirin (ASA) use for secondary prevention in patients with cardiovascular (CV) disease is well established through its beneficial effects on the reduction of myocardial infarction, ischemic stroke and CV mortality. This beneficial effect of ASA seems to consistently outweigh the risk in most patient subsets. Current guidelines endorse ASA for primary prevention of CV events in adults who are at moderate-high risk of CV morbidity. ⋯ The following manuscript describes the data emerging from contemporary trials regarding the efficacy and safety of ASA in various patient subsets. The authors propose certain strategies to enhance safety and efficacy in order to augment the beneficial effects of ASA along with other modalities of primary prevention for suitable candidates. When contemplating ASA prescription for primary prevention of CV events, physicians should carefully weigh the potential benefits of risk reduction versus likelihood of harm, mostly related to bleeding complications.
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The aim of this study was to investigate the accuracy of a critical pathway in the early stratification and management of patients with chest pain and suspected acute coronary syndrome (ACS) in the Emergency Department (ED). ⋯ A critical pathway, based on clinical and ECG features, is a safe and accurate tool to stratify and manage the patients with non-traumatic chest pain and suspected ACS in the ED.
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Randomized Controlled Trial
Is hyaluronate sodium effective in the management of knee osteoarthritis? A placebo-controlled double-blind study.
The aim of this study was to investigate the effect of intra-articular hyaluronic acid (HA) injection on pain and function in knee osteoarthritis (OA). ⋯ HA treatment was effective in the management of knee OA and improved knee pain and functional outcome, but there was no statistically significant difference in functional and symptom improvement with respect to saline (placebo) injection.
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The patients undergoing major orthopedic surgery, which includes total hip replacement (THR), total knee replacement (TKR), and hip fracture surgery (HFS), represent a group that has a particularly high risk for venous thromboembolism (VTE), and routine thromboprophylaxis has been standard of care for >20 years. The following article summarizes data derived from numerous randomized clinical trials of thromboprophylaxis following THR, TKR, and HFS; areas of orthopedic surgery for which there are much less data, including knee arthroscopy and isolated lower extremity injuries, are also reviewed.