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NIHR Signal A temporary clot-catching filter inserted after major trauma does not prevent lung clots
In adults after major trauma who cannot safely be given anti-clotting drugs, placing a removable metal filter in a major vein to the heart (the inferior vena cava) within 3 days of admission does not reduce their chances of having a clot in their lungs (pulmonary embolus) within 90 days, compared with having no filter. The filters do not affect the risk of bleeding. The filter aims to catch clots that might develop in the legs and travel to the lungs, until anti-clotting drugs can be safely sta...
NIHR Signal Routine use of progesterone does not prevent miscarriage
Progesterone did not affect the chance of live birth among women presenting with vaginal bleeding in the first 12 weeks of pregnancy. Live birth rates were 72% with placebo and 75% with progesterone, which is not a clinically or statistically important difference. Progesterone has been prescribed for threatened miscarriage in some centres since the 1950s, but there has been poor evidence for its use. NICE recently highlighted this as a priority area for research asking for large, robust trials ...
NIHR Signal 5% fluorouracil cream is the best first-line treatment for actinic keratosis skin lesions
Comparison of four common treatment regimens for actinic keratosis found that twice daily 5% fluorouracil cream was the most effective and least expensive. It was also found to be convenient and well tolerated by patients. Actinic keratosis, also known as solar keratosis, is a scaly skin lesion that develops following long-term sun exposure. It is a common disease in older adults that very occasionally can develop into skin cancer. This Dutch study assessed 624 patients who had five or more ac...
NIHR Signal Treating asymptomatic MRSA on discharge from hospital reduces risk of later infection
Use of medicated creams, mouthwash and body wash for six months after discharge from hospital led to a 30% lower risk of MRSA infection, compared with basic hygiene education. This study was carried out in the USA using 2,121 adults who had tested positive for MRSA in hospital, but who had no symptoms. Meticillin-resistant Staphylococcus aureus (MRSA) bacteria have developed resistance to widely-used antibiotics. MRSA is easily transferable within healthcare settings, and people may become colo...
NIHR Signal When is it best to start the Parkinson’s drug, levodopa?
Earlier treatment with levodopa provides symptomatic relief to those with symptoms but does not appear to slow Parkinson’s disease from progressing. Therefore, timing is best determined by symptoms. The treatment of Parkinson’s disease is complex. Levodopa is the main drug used to reduce tremors and muscle stiffness. Whether it modifies the course of the disease or becomes less effective over time is debated, and it can have side effects, so patients and clinicians sometimes prefer ...
NIHR Signal One gram a day of omega-3 supplements does not reduce the risk of cancer or cardiovascular disease
A trial of omega-3 fatty acid supplements showed they have little or no effect on the risk of cancer or cardiovascular disease in the general population. The finding contradicts the widespread belief that these supplements at usual doses protect the heart. A large trial of 25,871 men and women in the United States compared the impact of taking about 1g a day of omega-3 fatty acid supplements with placebo on major cardiovascular events and invasive cancer. The results are consistent with a recen...
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 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...
NIHR Signal The benefits and harms of aspirin for people with type 2 diabetes are finely balanced
Daily aspirin reduced the risk of serious vascular events among people with diabetes, while increasing the risk of major bleeding to a similar extent. Aspirin prevented one person in every 100 from having a heart attack or stroke over seven years, but an additional person per 100 experienced a major bleed. The ASCEND study is one of three large placebo-controlled trials investigating the effects of 100mg daily aspirin for primary prevention in people without established cardiovascular disease. ...
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