Cochrane Db Syst Rev
-
Cochrane Db Syst Rev · Jan 2000
ReviewDuration of treatment with vitamin K antagonists in symptomatic venous thromboembolism.
Currently the most frequently used secondary treatment for patients with venous thromboembolism are vitamin K antagonists targeted at an INR of 2.5 (range 2.0 - 3.0). However, based on the continuing risk of bleeding and uncertainty regarding the risk of recurrent venous thromboembolism, there is discussion on the proper duration of treatment with vitamin K antagonists for these patients. Recently, several studies were published in which the risk and benefits of different durations of oral anticoagulants were compared in patients with venous thromboembolism. ⋯ In conclusion this meta-analysis shows that treatment with vitamin K antagonists reduces the risk of recurrent venous thromboembolism as long as it is used. However, the absolute risk of recurrent venous thromboembolism declines over time, while the risk for major bleeding remains. Thus, the efficiency of vitamin K antagonist administration decreases over time since the index event.
-
Cochrane Db Syst Rev · Jan 2000
ReviewPharmacological interventions for spasticity following spinal cord injury.
Spasticity is a major health problem for patients with a spinal cord injury (SCI) that limits patients' mobility and affects independence in activities of daily living and work. Spasticity may also cause pain, loss of range of motion, contractures, sleep disorders and impair ambulation in patients with an incomplete lesion. The effectiveness of available drugs is still uncertain and they may cause adverse effects. Assessing what works in this area is complicated by the lack of valid and reliable measurement tools. The aim of this systematic review is to critically appraise and summarise existing information of the effectiveness of available treatments and to identify areas where further research is needed. ⋯ There is insufficient evidence to assist clinicians in a rational approach to antispastic treatment for SCI. Further research is urgently needed to improve the scientific basis of patient care.
-
To estimate the short-term efficacy and toxicity of methotrexate (MTX) for the treatment of rheumatoid arthritis (RA). ⋯ Twenty-two percent of people on MTX withdrew due to adverse effects compared to seven percent of the placebo group. MTX has a substantial clinically and statistically significant benefit in the short term treatment of patients with RA.
-
Aspirin has been known to be an effective analgesic for many years and is commonly used throughout the world for many different pain conditions. It is important for both prescribers and patients to have the best possible information about the efficacy and safety of analgesics, and this need is reflected in patient surveys which show that postoperative pain is often poorly managed. We also need to benchmark relative efficacy and safety of current analgesics so that we can compare them with new analgesics. ⋯ Aspirin is an effective analgesic for acute pain of moderate to severe intensity with a clear dose-response. Drowsiness and gastric irritation were seen as significant adverse effects even though the studies were single-dose. The pain relief achieved with aspirin was very similar milligram for milligram to that seen with paracetamol.
-
Cochrane Db Syst Rev · Jan 2000
ReviewLow-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke.
Low molecular weight heparins and heparinoids may be associated with lower risks of haemorrhage and more powerful antithrombotic effects than standard unfractionated heparin. ⋯ Low molecular weight heparin or heparinoid appear to decrease the occurrence of deep vein thrombosis compared to standard unfractionated heparin, but there are too few data to provide reliable information on their effect on other important outcomes, including death and intracranial haemorrhage.