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NIHR Signal Prolonging anticoagulant treatment after abdominal cancer surgery reduces clot risk
People who have low molecular weight heparin (LMWH) for between two to four weeks after abdominal or pelvic surgery, especially for cancer, have fewer blood clots in their large veins or lungs. In this review of seven trials, five per cent of people receiving extended treatment experienced a clot compared with 13% who received LMWH only while in hospital. There was no difference in bleeding complications. The optimal duration of treatment following abdominal surgery is uncertain, balancing blee...
NIHR Signal A high omega-6 fatty acid diet is unlikely to prevent cardiovascular disease or deaths
Diets or supplements that aim to increase omega-6 fatty acids have no clear effect on the risk of cardiovascular events like heart attacks or stroke, overall deaths or deaths from cardiovascular disease. Omega-6 fatty acids are poly-unsaturated oils largely derived from seeds and nuts such as sunflower oil, corn oil, soybean oil, walnuts and pumpkin seeds. The results of this Cochrane review can be looked at alongside another recent Cochrane review, which found no benefits of fish oil in omega-...
NIHR Signal New strategies for maintaining blood supplies from donations may be cost-effective
Opening blood donation centres on weekday evenings and at weekends is a cost-effective way of increasing the blood supply used by hospitals in the UK. Allowing donors to give blood more often could increase supplies in the short term, but it isn’t clear if it would be cost-effective in the long-term. This NIHR-funded modelling study used data from a recent large randomised trial in the UK that investigated the safety of donating blood more frequently than current guidance allows. This was...
NIHR Signal Warfarin and newer anticoagulants equally effective for long-term treatment of blood clots
Warfarin and newer anticoagulants work equally well to prevent blood clots in extended treatment after venous thromboembolism. One clot is prevented for every 15 people receiving either anticoagulant. Aspirin is ineffective. Following venous thromboembolism – a blood clot in the deep leg veins (deep vein thrombosis) or lungs (pulmonary embolism) – anticoagulant treatment is given for three months, as standard. Prolonged treatment may be given for patients at high risk of recurrence....
NIHR Signal Lifestyle changes may be more important than drugs for mild hypertension
Consideration of wider risk factors may be important when treating adults with low-risk mild hypertension (raised blood pressure). A large NIHR-funded UK study compared rates of mortality and risk of cardiovascular disease between patients who received antihypertensive treatment and those who did not. There was an increased risk of adverse effects, like low blood pressure. It found no evidence to support starting drug treatment for adults of low-cardiovascular risk with mild hypertension. This...
NIHR Signal Premature babies have fewer complications if a lower platelet count is accepted
Fewer premature babies die or have major bleeding if platelet transfusions are withheld until platelet numbers drop to a lower level. At 28 days, death or new major bleeding occurred in 19% of neonates transfused when they had less than 25,000/mm3 platelets compared to 26% of neonates transfused when they had less than 50,000/mm3 platelets. This trial included 660 premature babies with low platelet counts. The results suggest that in the absence of actual bleeding, platelet transfusions may be...
NIHR Signal The benefits of commonly used blood pressure and cholesterol lowering treatment can last 16 years
Fewer deaths from stroke had occurred in people who had high blood pressure treated with amlodipine, a calcium-channel blocker, compared to atenolol, 10 years after the end of a large trial. People with high blood pressure who took statins were less likely to die from cardiovascular diseases, such as heart disease or stroke than those taking a placebo. This study followed over 7,000 UK patients who had taken part in a clinical trial of blood pressure and cholesterol-lowering treatments between ...
NIHR Signal Home-based cardiac rehabilitation for heart failure has high rates of participation
Home-based cardiac rehabilitation for people with heart failure improves quality of life at 12 months compared with usual care. Among those allocated to rehabilitation, 90% remained in the programme – more than double average attendance rate for hospital-based rehabilitation. The average cost was estimated at £418 per participant which is within the National Health Service tariff for cardiac rehabilitation in England of £477 per patient. This NIHR-funded trial included 216 par...
NIHR Signal People leaving hospital after medical illness do not benefit from extended clot reducing treatment
Taking rivaroxaban after discharge from hospital does not significantly reduce the risk of venous thromboembolism, either blood clots in large veins or of dying from clots travelling to the lungs. People who are hospitalised with conditions such as heart failure and stroke are at an increased risk of blood clots. This risk is further increased by factors such as age, lack of mobility and previous illness or clots. These patients will usually be given anticoagulant treatment to reduce blood clot...
NIHR Signal Aspirin did not prevent deaths or disability in healthy older adults
In the ASPREE trial, older adults with no apparent cardiovascular disease who took daily aspirin saw no benefit in terms of reducing the chance of dying or having dementia or disability. Instead, it slightly increased their mortality and bleeding risk - aspirin was associated with an excess of 1.6 deaths per 1,000 people per year. Half of these deaths were due to cancer. Aspirin is an established ‘secondary’ preventative treatment for people who have known cardiovascular disease. Ho...
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