Episode 81: New studies about Vit K/INR, PUD, GABHS and statins
- Download the MP3 (Right Click, ...Save As)
In episode 81, Mike and James talk about new studies. They run the gamut from Vitamin K, sequential therapy for peptic ulcer disease, single dose steroids for Strep throat and yet another meta-analysis of statin therapy.
Comments
It seems to me that the point
It seems to me that the point is: Statins reduce the risk of cardiovascular events. True, there has been little evidence that this is true in women but that is, (don't you think?), just the consequence of another point you make well: That the drug works the same no matter who takes it: but the magnitude of that absolute risk reduction is entirely dependent on the baseline risk of your victim, er, patient. So it's easier to show a benefit of risk reduction in a patient who has had an MI than it is in an asymptomatic, young female. Mark
Hi James: I have been
Hi James:
I have been reducing the does on many medications (or stopping) with good success. With statins and primary prevention, mainly due to cost I have been switching from atorvistatin to simvistatin on a regular bases. Normally the literature says atrovistatin 20 mg would = simvistatin 40mg. I also see the data says doubling a statin dose will give you an extra 6% reduction in LDL. So the questions is why not just go with 20 mg atorvistatin to simvistatin 20 mg, reducing the dose and reducing the chance of side effects? A reduction of 6% of the LDL by doubling a statin dose does not seem worth the increased risk of side effects when the goal is risk reduction of a cardio vascular event not the marker itself. Just taking the drug will give the best outcome. So like most things just give the lowest possible dose not the “equivalent dose” Please comment on this.
John
When a patient has a sore
When a patient has a sore throat that you suspect is viral or even mononucleosis, would it be reasonable to use a single steroid dose in these instances too? (Or for that matter, while you wait for a swab result to be cultured?) Mike said specifically the steroid use was for someone you were starting on antibiotics in this podcast. But a Journal Watch 2009 article indirectly attached to your reference above, suggested it worked even though only 44% of the patients had strep throat. (Although it worked better in these cases). Also, the same article suggested steroids did NOT work in the pediatric population (www.emergency-medicine.jwatch.org/cgi/content/full/2009/828/1)
Thanks for the response,
Thanks for the response, Mike. Do you ever get cataracts or avascular necrosis from a single dose of steroids? I had taken from the podcast that we should consider steroids a bit more often for sore throats as really there is not much harm and could be a fair bit more comfort; up until now I agree with you I was using them very rarely, for very bad throats and potentially compromised airways in addition to the ENT referral. But why not try them a bit more often if we have a bit of evidence for this now?
Post new comment