Although warfarin has been, and probably still is, the most commonly used anticoagulant it is well known to be difficult to use. Dabigatran, a direct thrombin inhibitor has been shown to be equal or possibly superior to warfarin in reduction of stroke related to atrial fibrillation. It has the advantage that frequent blood tests are not required for the patient. It has the disadvantage that unlike warfarin there is no antidote if significant bleeding occurs.
This report concerns a prospective study of the use of dabigatran. 92 patients were recruited to the study. At a median of 8 months, 70% were still taking the drug. Upper gastrointestinal adverse effects were by far the commonest reason for discontinuation of the drug. Most who discontinued dabigatran did so within a few days of initiation of their treatment. The addition of a proton pump inhibitor proved useful for some patients.
Internal Medicine Journal 2014;44:261–265.
Diabetes as a risk factor for stroke in women
This research group has previously published findings that the relative risk of diabetes-related coronary heart disease is substantially higher in women than men. This report concerns the relative risk of diabetes and stroke in the two genders.
Data from 64 cohort studies representing more than three-quarters of a million individuals and more than 12,000 fatal and non-fatal strokes were included in the analysis. The relative risk of stroke associated with diabetes was 2.28 in women and 1.83 in men. The pooled ratio of relative risks demonstrated that women had a greater risk than men (1.27). The sex differential was consistent over the studies.
The authors suggest that the excess risk is due to women having a chronically raised cardiovascular risk profile in the prediabetic state, which is more likely to be undetected and therefore untreated than in men.
Chronic hypertension and pregnancy outcomes
It is well known that hypertensive disorders of pregnancy are responsible for considerable fetal and maternal morbidity and mortality. This meta-analysis considers prenatal hypertension and its effects on fetal and maternal outcomes. 55 studies from 25 different countries have been included. The pregnancy complications of the patients with chronic hypertension are compared with the general pregnancy population in the United States.
The researchers report that the relative risk for superimposed pre-eclampsia compared with pre-eclampsia to be 7.7. The relative risk for caesarean section is 1.3. The relative risk for pre-term delivery before 37 weeks is 2.7 and for birth weight below 2500g is also 2.7. The relative risk for neonatal unit admission is 3.2 and 4.2 for perinatal death. These findings emphasise a need for heightened antenatal surveillance of such patients.