Drug and therapeutics bulletin
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Clopidogrel (Plavix-Sanofi Winthrop/Bristol-Myers Squibb) and [symbol: see text] ticlopidine (Ticlid-Sanofi Winthrop) are inhibitors of platelet function and are promoted as potential alternatives to aspirin. Clopidogrel is licensed for the secondary prevention of vascular events in patients with established atherosclerotic disease. ⋯ However, in the UK, ticlopidine is more commonly used with aspirin to prevent complications following insertion of coronary stents during angioplasty. We consider whether the claims for clopidogrel and the current use of ticlopidine are justified.
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Back pain is very common. In the UK, there were about 14 million GP consultations for back pain in 1993 and around 60-80% of the population will have had it at some time during their lives. Many attacks resolve quickly but some patients go on to develop chronic back pain and a few develop severe, long-term disability. Here we discuss the natural history, diagnosis and management of acute low back pain, focusing on simple low back pain, in which the pain is uncomplicated by nerve root involvement or serious spinal pathology.
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Results of large randomised controlled trials may not help in deciding treatment for an individual patient. This may be because the patient differs clinically from those in the trials, or because wide variations between individuals in a trial limit the applicability of results to an individual patient. ⋯ This approach may also help when the prescriber or patient doubts whether the treatment is, or will be, beneficial, when the optimal dosage is uncertain, or to assess whether an unwanted effect is due to a particular treatment. Here we discuss the use of this technique.