Prescrire international
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Prescrire international · Nov 2012
Randomized Controlled Trial Multicenter StudyAcute coronary syndrome and rivaroxaban: not so fast...
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Prescrire international · Nov 2012
Rivaroxaban and atrial fibrillation: continue to use warfarin or in some cases, dabigatran.
Warfarin, at a dose adjusted according to the INR, is the standard prophylactic anticoagulant for patients with atrial fibrillation and a major risk of thrombosis. Dabigatran, a thrombin inhibitor, is an alternative when warfarin fails to maintain the INR within the therapeutic range most of the time. Warfarin and aspirin are reasonable choices for patients at moderate risk of thrombosis. ⋯ Combination with other antithrombotic drugs should be avoided. In practice, warfarin remains the standard prophylactic drug for patients with atrial fibrillation and a major risk of thrombosis, while dabigatran is an alternative in cases that are difficult to manage. In mid-2012, the data on rivaroxaban are not sufficiently convincing to challenge this standard.
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Prescrire international · Oct 2012
ReviewManagement of localised prostate cancer: watchful waiting, surgery or radiation therapy, depending on the natural course, which is often relatively slow.
Localised prostate cancer, confined to the prostate gland, occurs mainly in men over 65 years of age. The principal management options are watchful waiting, prostatectomy and radiation therapy. Which of these options has the best harm-benefit balance for patients with localised prostate cancer? To answer this question, we conducted a review of the literature using the standard Prescrire methodology. ⋯ Patients should be informed of the risks associated with each of these options and should be actively involved in the choice of treatment. Treatment is often warranted for patients with high-risk localised prostate cancer. The main options are either radical prostatectomy or external beam radiation therapy combined with hormone therapy.