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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. ...
NIHR Signal Fish oil supplements do not reduce cardiovascular deaths in people with diabetes without existing vascular disease
Omega-3 fatty acid supplements make no difference to cardiovascular outcomes in people with diabetes but without established cardiovascular disease. Serious vascular events like heart attack, stroke or deaths from these occurred in about 10% of people regardless of whether they took daily omega-3 or placebo capsules for seven years. The ASCEND studyis a large UK trial assessing primary cardiovascular prevention for people with any type of diabetes. A companion publication assesses the use of as...
NIHR Signal ‘Artificial pancreas’ improves glucose control in hospital patients with type 2 diabetes
Closed-loop insulin pumps, which continuously monitor blood glucose and administer insulin accordingly, can improve blood glucose control among patients with type 2 diabetes admitted to hospital for non-critical care. Those using the system spent about six hours longer in the target range, and this could hasten their recovery and reduce staff workload. The number of hospitalised patients with type 2 diabetes is increasing. Glucose control often worsens during illness. Closed-loop pumps have bee...
NIHR Signal Sodium thiosulfate reduces hearing loss in children treated with chemotherapy
Treatment with sodium thiosulfate alongside cisplatin chemotherapy can reduce hearing loss in children with a liver tumour called hepatoblastoma. The risk of hearing loss was reduced by 48% in children who had the combination treatment compared with those who had cisplatin only. This phase 3 trial involved 109 children with standard-risk hepatoblastoma and tested the addition of sodium thiosulfate six hours after cisplatin treatment. The additional drug caused few major side effects, and there ...
NIHR Signal Supporting families of those in intensive care improved family satisfaction but didn’t reduce family distress
A multicomponent support intervention for family members of patients in intensive care didn’t reduce their anxiety, depression or distress around the overall experience. However, it increased satisfaction with the quality of staff communication and delivery of care. Family members of critically unwell patients on intensive care often need to be involved in care decisions. Yet they may feel unsupported and bewildered in the process. This intervention, delivered in five US intensive care un...
NIHR Signal Financial incentives may help workers quit smoking
Financial incentives, when given alongside free smoking cessation aids, improved abstinence rates compared with free cessation aids or motivational information alone. This workplace-based US trial assigned 6,000 smokers, unselected for willingness to quit, to information only, free e-cigarettes, free nicotine replacement or drug therapy, or free cessation aids with a $600 reward in one of two ways. Quit rates at six months were very low though the substantial financial incentive increased the r...
NIHR Signal Two antiplatelet drugs may prevent further strokes but increase major bleeds
People experiencing a minor stroke or a transient ischaemic attack have a lower risk of further stroke within 90 days if given clopidogrel and aspirin, rather than aspirin alone. However, taking both drugs doubles the risk of bleeding over the same period. Current UK guidelines recommend using clopidogrel alone. In this major international trial of nearly 5,000 people, those who took the dual treatment had fewer heart attacks or strokes than those who took aspirin only, particularly in the fir...
NIHR Signal High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis
A randomised controlled trial of 1,472 infants with bronchiolitis found that more children improved when started on high-flow oxygen therapy than with standard oxygen therapy. Those who failed to improve on standard therapy were switched to high flow oxygen. Most then improved - overall, similar numbers were transferred to intensive care. There was also no difference between the groups in the proportion of infants needing intubation, length of time on oxygen therapy or days spent in hospital. ...
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