Arch Intern Med
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Orthopedic surgery remains a condition at high risk of venous thromboembolism (VTE). Fondaparinux, the first of a new class of synthetic selective factor Xa inhibitors, may further reduce this risk compared with currently available thromboprophylactic treatments. ⋯ In patients undergoing orthopedic surgery, 2.5 mg of fondaparinux sodium once daily, starting 6 hours postoperatively, showed a major benefit over enoxaparin, achieving an overall risk reduction of VTE greater than 50% without increasing the risk of clinically relevant bleeding.
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Comparative Study
Overweight and obesity as determinants of cardiovascular risk: the Framingham experience.
To our knowledge, no single investigation concerning the long-term effects of overweight status on the risk for hypertension, hypercholesterolemia, diabetes mellitus, and cardiovascular sequelae has been reported. ⋯ The overweight category is associated with increased relative and population attributable risk for hypertension and cardiovascular sequelae. Interventions to reduce adiposity and avoid excess weight may have large effects on the development of risk factors and cardiovascular disease at an individual and population level.
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There have been no studies of interventions to reduce test utilization in the coronary care unit. ⋯ The utilization management intervention was associated with significant reductions in test ordering without a measurable change in clinical outcomes.
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A post-dural puncture headache is a potential complication of a lumbar puncture. Physicians should be able to readily diagnose and treat this potential complication. ⋯ A subdural hematoma is a rare complication following lumbar punctures. Unresolving headaches following a lumbar puncture should prompt aggressive investigation.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study.
The use of warfarin sodium for treating venous thromboembolism in patients with cancer is associated with a significant risk of recurrence and bleeding. The use of low-molecular-weight heparin sodium for secondary prevention of venous thromboembolism in cancer patients may reduce the complication rate. ⋯ These results confirm that warfarin is associated with a high bleeding rate in patients with venous thromboembolism and cancer. Prolonged treatment with low-molecular-weight heparin may be as effective as oral anticoagulants and may be safer in these cancer patients.