The Clinton Herald, Clinton, Iowa


February 6, 2014

Anxiety linked to higher risk


Warfarin is the most common treatment for atrial fibrillation and proper dosing is critical. Recent analyses have suggested that newer drugs may be as effective as warfarin in preventing strokes, and may reduce the risk of some bleeding complications.

Two studies found that using genetic testing to determine the best dose of warfarin may not be worth the extra testing and cost.

Other studies compared warfarin to newer drugs called novel oral anticoagulants. A meta-analysis compared four of them and found they significantly reduced stroke, bleeding in the brain, and death, although they increased gastrointestinal bleeding.

8. Simplifying the cooling of cardiac arrest patients and extendinglife support

Resuscitation studies provided guidance on cooling cardiac arrest patients — called therapeutic hypothermia — and on how long to provide life support after they’ve been rewarmed. Cooling patients who have survived sudden cardiac arrest can improve their survival and brain function, and two studies suggest simplifications to the process. The first suggested that cooling before patients reach the hospital did not help their survival or brain function. The second study found no differences in survival or brain function for patients cooled to 33 degrees Celsius vs. 36 degrees Celsius. Incorporating these ideas could save emergency medical services from investing in special equipment and training, and hospitals can more easily lower their patients’ temperatures.

After cooling and rewarming, another study recommends that healthcare providers wait 48-72 hours before withdrawing life support, because patients can still survive with good brain function after 72 hours. Before therapeutic hypothermia is used, most patients are put into a medically induced coma.

9. Endovascular treatment for stroke

Several studies evaluated the use of endovascular treatment of strokes caused by blocked blood vessels supplying the brain. Endovascular treatment either delivers tissue plasminogen activator (tPA) near the blockage in the blood vessel or mechanically restores blood flow in the vessel. Most studies found it led to more blood vessels supplying the brain being open after treatment, but newer studies did not demonstrate that this led to better outcomes for patients than standard drug treatment, intravenous tPA.

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