May 7th, 2015

Selections from Richard Lehman’s Literature Review: May 7th

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

JAMA 28 April 2015 Vol 313

Effect of a Retrievable Inferior Vena Cava Filter Plus Anticoagulation vs Anticoagulation Alone on Risk of Recurrent Pulmonary Embolism (pg. 1627): About 30 years ago, one of my patients returned from the US with a filter in his inferior vena cava, having had a very expensive pulmonary embolus in the land of the free. This procedure has never caught on in the NHS, and a good thing too. But it persists across the Atlantic, despite many trials proving its lack of effect. The latest shows that “Among hospitalized patients with severe acute pulmonary embolism, the use of a retrievable inferior vena cava filter plus anticoagulation compared with anticoagulation alone did not reduce the risk of symptomatic recurrent pulmonary embolism at 3 months.”

Ann Intern Med 21 April 2015 Vol 162

Cost-Effectiveness and Population Impact of Statins for Primary Prevention in Adults Aged 75 Years or Older in the United States (pg. 533):  Last year I had several tries at writing a short critique of the National Institute for Health and Care Excellence guideline on statins, but in the end I had such a severe hemiplegic migraine that I decided that I might die in the attempt. Fortunately, others have risen to the challenge, and I hope that continuing debate about this issue will mark a turning point in our conceptualisation of population risk and how to make decisions with individuals. One of the most extraordinary recommendations was to offer all people over the age of 85 a statin because of their 10+% risk of a cardiovascular event. In this paper, an attempt is made to predict the cost effectiveness of statin treatment of all American adults aged 75 to 94 years using Markov modelling. Do access it if you are interested, but to me it just proves how inadequate the data are to support such modelling, even if it was legitimate to apply it . . . But don’t get me started. I can feel a migraine coming on.

The BMJ 2 May 2015 Vol 350

Risk of GI Bleeding Associated with Oral Anticoagulants: Stents, mabs, and NOACs. They’ve dominated the journals these last 17 years, and I hope you haven’t grown as weary trying to follow them as I have trying to write about them. NOACs are novel oral anticoagulants. Throughout the 2000s, they started pouring from the drug companies. These exciting drugs promised an end to the need for warfarin and blood testing. One week it would be apixaban for atrial fibrillation. The next week it might be dabigatran for VTE. As they proliferated, and one began to multiply all the drugs by all the indications by all the comparisons, it seemed that the line might stretch to th’ crack of doom. One began to lose the will to read, if not to live. This week’s BMJ attempts a reality check in the form of two American papers comparing dabigatran v rivaroxaban v warfarin for all indications in relation to the risk of gastrointestinal bleeding. They are much of a muchness, within wide confidence intervals.

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