Prescrire international
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Prescrire international · Feb 2012
Review Comparative StudyDabigatran and atrial fibrillation: the alternative to warfarin for selected patients.
For patients with atrial fibrillation and a high risk of thrombosis, the standard prophylaxis is warfarin, an anticoagulant, at a dose adjusted to the INR. Warfarin and aspirin are both reasonable choices for patients with a moderate risk of thrombosis. Dabigatran, an oral anticoagulant that inhibits thrombin, has been authorised for patients with atrial fibrillation and a moderate or high risk of thrombosis, without associated valvular abnormalities. ⋯ In practice, warfarin remains the standard drug for patients with atrial fibrillation and a moderate or high risk of thrombosis. Aspirin is an alternative for moderate-risk patients. When the risk is significant and the INR cannot be maintained within the target range despite close monitoring, dabigatran is the alternative to warfarin, provided the patient is closely monitored, especially for changes in renal function.
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Prescrire international · Feb 2012
ReviewPregnancy and alcohol: occasional, light drinking may be safe.
Many pregnant women drink varying quantities of alcohol, although several guidelines recommend total abstinence. What is known of the dangers of alcohol for the outcome of pregnancy and for the unborn child? To answer this question, we conducted a review of the literature using the standard Prescrire methodology. Fetal alcohol syndrome, which combines facial dysmorphism, growth retardation and intellectual disability, occurs in about 5% of children who are regularly exposed to at least five standard units per day (about 50 g of alcohol per day). ⋯ A clinical trial showed that women with at-risk drinking were more likely to reduce their consumption if they were informed of the risks for their pregnancy and their unborn child on several occasions than if they were simply given an information leaflet. In practice, women must be informed of the risks of alcohol consumption during pregnancy, but this must be done tactfully. The risks of minimal alcohol consumption should not be overstated.