No abstract

Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

No abstract

Hospitalizedp atientsw ith acute medicalc onditionsa re at significantriskofvenous thromboembolism (VTE): approximately 10-30% of general medical patients mayd evelop deep-vein thrombosis or pulmonaryembolism, andthe latter is aleading contributortodeaths in hospital. Despite consensus-group recommendations that at-riskm edical patients should receive thromboprophylaxis, there is currentlyn oc onsensusa st o which patients areatrisk,and manypatientsmay not receiveappropriate thromboprophylaxis.This paperreviews evidence for the risk of VTE associated with differentmedical conditions and riskfactors, and presents arisk-assessment modelfor risk stratification in medical patients. Medicalconditionsassociated with Keywords Medical illness, risk-assessment model, thromboprophylaxis, venous thromboembolism amoderate to high risk of VTE include cardiac disease,cancer, respiratorydisease,inflammatorybowel disease,and infectious diseases. Importantly, analyseso fd ata from theM EDENOX study show that thromboprophylaxiss ignificantly reducest he risk of VTE in these patient subgroups.Riskfactors in medical patientsincludeahistory of VTE,historyofmalignancy,increasing age, thrombophilia, prolongedimmobility, and obesity.These medical conditions and riskfactors areincluded in arisk-assessment modelw hich is hoped will provideasimple means of assisting clinicians in deciding whethert hromboprophylaxis should be used in an individual patient.

Background: A variety of antiarrhythmic drugs have been used to prevent recurrence of atrial fibrillation after conversion to sinus rhythm. We performed a systematic review to determine the effect of long-term treatment with those drugs on death, embolisms, adverse effects, and atrial fibrillation recurrence.Methods: We searched MEDLINE, EMBASE, the Cochrane Library (all up to May 2005), and the reference lists of retrieved articles. We included randomized controlled trials that compared any antiarrhythmic against control (placebo or no treatment) or another antiarrhythmic, for more than 6 months. Postoperative atrial fibrillation was excluded. Two evaluators independently reviewed the retrieved studies and extracted all data. Disagreements were resolved by discussion. All results were calculated at 1 year of follow-up.Results: Forty-four trials were included, with a total of 11 322 patients. Several class IA (disopyramide phos-phate, quinidine sulfate), class IC (flecainide acetate, propafenone hydrochloride), and class III (amiodarone, dofetilide, sotalol hydrochloride) drugs significantly reduced recurrence of atrial fibrillation (number needed to treat, 2-9), but all increased withdrawals due to adverse effects (number needed to harm [NNH], 9-27) and all but amiodarone and propafenone increased proarrhythmia (NNH,. Class IA drugs, pooled, were associated with increased mortality compared with controls (Peto odds ratio, 2.39; 95% confidence interval, 1. P=.04; NNH, 109). No other antiarrhythmic showed a significant effect on mortality compared with controls. We could not analyze other outcomes because data were lacking. Conclusion:Class IA, IC, and III drugs are effective in maintaining sinus rhythm but increase adverse effects, and class IA drugs may increase mortality.

BackgroundAtrial fibrillation is the most frequent sustained arrhythmia. Atrial fibrillation frequently recurs after restoration of normal sinus rhythm. Antiarrhythmic drugs have been widely used to prevent recurrence, but the effect of these drugs on all-cause mortality and other clinical outcomes is unclear. This is an update of a review previously published in 2007, 2012 and 2015. risk of mortality was higher in people taking quinidine, although the confidence interval also includes the possibility of no difference (RR 2.01, 95% CI 0.84 to 4.77; participants = 1646).No effect on mortality was apparent with the remaining drugs studied, but less data was available for them and it could be underpowered to detect small increases in mortality. In particular, very few data was available for flecainide (no death reported in any treatment arm in 4 RCTs studying flecainide, participants = 511) and propafenone (only 2 deaths reported in 5 included RCTs, participants = 998).

The use of enoxaparin plus elastic stockings with graduated compression, as compared with elastic stockings with graduated compression alone, was not associated with a reduction in the rate of death from any cause among hospitalized, acutely ill medical patients. (Funded by Sanofi; LIFENOX ClinicalTrials.gov number, NCT00622648.).

Diarrhoea is a relatively frequent adverse event, accounting for about 7% of all drug adverse effects. More than 700 drugs have been implicated in causing diarrhoea; those most frequently involved are antimicrobials, laxatives, magnesium-containing antacids, lactose- or sorbitol-containing products, nonsteroidal anti-inflammatory drugs, prostaglandins, colchicine, antineoplastics, antiarrhythmic drugs and cholinergic agents. Certain new drugs are likely to induce diarrhoea because of their pharmacodynamic properties; examples include anthraquinone-related agents, alpha-glucosidase inhibitors, lipase inhibitors and cholinesterase inhibitors. Antimicrobials are responsible for 25% of drug-induced diarrhoea. The disease spectrum of antimicrobial-associated diarrhoea ranges from benign diarrhoea to pseudomembranous colitis. Several pathophysiological mechanisms are involved in drug-induced diarrhoea: osmotic diarrhoea, secretory diarrhoea, shortened transit time, exudative diarrhoea and protein-losing enteropathy, and malabsorption or maldigestion of fat and carbohydrates. Often 2 or more mechanisms are present simultaneously. In clinical practice, 2 major types of diarrhoea are seen: acute diarrhoea, which usually appears during the first few days of treatment, and chronic diarrhoea, lasting more than 3 or 4 weeks and which can appear a long time after the start of drug therapy. Both can be severe and poorly tolerated. In a patient presenting with diarrhoea, the medical history is very important, especially the drug history, as it can suggest a diagnosis of drug-induced diarrhoea and thereby avoid multiple diagnostic tests. The clinical examination should cover severity criteria such as fever, rectal emission of blood and mucus, dehydration and bodyweight loss. Establishing a relationship between drug consumption and diarrhoea or colitis can be difficult when the time elapsed between the start of the drug and the onset of symptoms is long, sometimes up to several months or years.