Weight-adjusted intravenous heparin therapy after APSAC in acute myocardial infarction does not reduce the combined incidence of death, reinfarction, recurrent ischemia and occlusion of the infarct-related artery. Furthermore, withholding intravenous heparin therapy is associated with a 46% reduction in bleeding complications. Our findings do not support the addition of intravenous heparin after APSAC therapy, as currently recommended, and suggest that a strategy of withholding heparin is simpler and safer and does not place the patient at increased risk for ischemic complications after myocardial infarction.
Primary (essential) hypertension has recently been related to calcium deficiency, rather than excess. The evidence used to support this hypothesis includes surveys showing lesser dietary intake of calcium, lower levels of ionized calcium in the blood, and reduction of blood pressure with calcium supplements. This critique examines each of these points and the theoretical construct used to explain the hypothesis. We conclude that the theoretical construct is based on the use of only a portion of available experimental data and the clinical evidence remains inconclusive. Until the hypothesis is supported further, calcium deficiency should not be accepted as a mechanism responsible for hypertension and calcium supplements should be used with caution.
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