Clinical Briefs-By Louis Kuritzky, MD
Clinical Briefs-By Louis Kuritzky, MD
Prevention of Pulmonary Embolism and Deep Vein Thrombosis with Low-Dose Aspirin
A variety of tools have been evaluated for their efficacy in reducing venous thromboembolism (DVT) post surgically and in other high-risk circumstances. Although heparin subcutaneously has been shown to reduce DVT risk by at least half, the benefit of this intervention remits once heparin is discontinued, usually at the time of hospital discharge. Despite the fact that antiplatelet therapies have been shown to reduce risk of MI and stroke, they have not been generally embraced as effective DVT prevention. Meta-analysis of antiplatelet therapy postsurgically indicates a 40% reduction in DVT and a 66% reduction of pulmonary embolism (PE). The current trial was devised to confirm (or refute) in a single prospective trial whether low-dose aspirin would reduce DVT in an at-risk population, specifically, persons undergoing orthopedic surgical procedures.
From 1992 to 1998, 13,356 patients were randomised to 160 mg/d of aspirin (begun the day of surgical intervention in 82% of cases, preoperatively) or placebo. Patients were followed up to 35 days.
Aspirin treatment was associated with a 29% reduction in DVT, and a 43% reduction in PE, compared with placebo. The frequency of fatal bleeding among hip-fracture patients was the same in aspirin and placebo recipients. The only demonstrated bleeding consequence detected more often in aspirin subjects was the frequency of postoperative bleeding requiring transfusion (2.9% vs 2.4%). The authors conclude that low-dose aspirin reduces risk of PE, fatal PE, and DVT.
Pulmonary Embolism Prevention Trial Collaborative Group. Lancet 2000;355:1295-1302.
As-Needed Use of Fluticasone Proprionate Nasal Spray Reduces Symptoms of Seasonal Allergic Rhinitis
It is likely that most clinicians anticipate chronic daily administration of nasal steroid therapy (NS) for many of their patients who are established as sufferers of seasonal allergic rhinitis. On the other hand, since NS pathophysiologically prevents inflammation from developing, prevents allergic priming, and blocks the late allergic response, dose administration for mild disease may have a somewhat durable effect. In contrast, antihistamines block only the immediate allergic response and have less effect as allergy season becomes more established and the late allergic response more activated. This placebo controlled study evaluated the use of fluticasone nasal spray (FNS) taken as needed for allergic rhinitis symptoms during allergy season (n = 56).
Over the course of 28 days, as-needed dosing resulted in an average of 14-16 dose administrations (placebo or FNS). Symptom scores among active drug recipients were dramatically lower (mean = 4.5) than placebo recipients (mean = 8.5), despite the fact that active medication was administered on only approximately half of the study days.
Jen and associates point out that it is likely that many patients administer NS less often than directed, or on an as-needed basis. This study suggests that even as-needed NS provides substantial relief to allergic rhinitis sufferers. COLOR=black>
Jen A, et al. J Allergy Clin Immunol 2000;105:732-738.
Efficacy and Safety of Sertraline Treatment of Post-Traumatic Stress Disorder
Although post-traumatic stress disorder (PTSD) used to be commonly considered a disorder of soldiers exposed to combat stressors, we now recognize that physical and sexual assault may result in the same chronic symptoms constellation. Literally, more than half of the entire U.S. population experiences at least one major traumatic event in their life, when one includes experiences like natural disasters, serious motor vehicle accidents, and witnessing serious injury to another.
The three characteristic domains of PTSD symptoms include re-experienced thoughts, avoidance of things associated with the trauma, and altered states of arousal when confronted with PTSD-associated factors. These symptoms may be chronic, with a median duration of 3-5 years. Few trials have addressed the efficacy of pharmacotherapy for PTSD. Since animal models of PTSD suggest that sertraline has some efficacy, and other SSRIs have shown some benefit, this large trial (n = 187) of men and women examined the effect of sertraline 50-200 mg q.i.d.
After 12 weeks of active treatment, three of four primary outcome measures were statistically significantly improved. Additionally, sertraline treatment was associated with improvement in social and occupational function, and improved quality of life. Overall, more than half of patients were much improved, experiencing a 79% reduction in symptom severity. Brady and colleagues conclude that sertraline is an effective treatment for PTSD.
Brady K, et al. JAMA 2000;283:1837-1844.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.