Can we allow low dose aspirin holidays?

Health Care, Medicine 166 Comments

Those at risk of heart attack or other cardiovascular events taking a low–dose aspirin holiday can increase their risk of developing a subsequent heart attack as per a large case–controlled study of 39513 patients aged 50–84 years by Dr Luis Garcia Rodriguez, of the Spanish Centre for Pharmacoepidemiologic Research in Madrid and published in British Medical journal.

Compared with those taking aspirin, individuals prescribed aspirin for secondary prevention, who had recently discontinued the drug, had a significantly increased risk of nonfatal heart attacks or death from coronary heart disease combined and nonfatal heart attacks

Aspirin holiday can cause four more cases of nonfatal heart attacks for every 1,000 patients over a period of one year.

The current American Heart Association/American College of Cardiology practice guidelines recommend 75 mg to 162 mg of aspirin as low dose aspirin per day.

Should we measure carotid intima media thickness in any cardiac risk assessment?

Health Care, Medicine, Social Health Community 275 Comments

Measuring maximum intima-media wall thickness of the internal carotid (neck) artery may boost the predictive power of Framingham risk scores as per Dr Joseph Polak, of Tufts University, and colleagues who reported their findings in the New England Journal of Medicine.

1.   Thickening in both arteries is used as a surrogate measure of atherosclerosis.

2.   In the common carotid it manifests as diffuse arterial wall thickening

3.   In the internal carotid artery, it’s a surrogate for focal atherosclerotic plaque

4.  Both are recognized tools for cardiovascular risk assessment

5.   To clarify the issue, Polak and colleagues analyzed data from 2,965 patients in the Framingham Offspring Study who were followed for an average of 7.2 years, and 296 of them had a cardiovascular event during that time.

6.     Plaque is defined as an intima-media thickness of more than 1.5 mm in the internal carotid artery. Plaque in ICA is a significant predictor of cardiovascular events.

7.     Recent American College of Cardiology and American Heart Association guidelines give common carotid artery intima-media thickness a level IIa recommendation for risk evaluation — the same level as ankle-brachial index and coronary artery calcium scoring.

8.    Intima-media thickness of the internal carotid artery should be measured in addition to the thickness of the common carotid artery for purposes of cardiovascular risk assessment.

Schedule HX is not patient–friendly

Health Care, Social Health Community 382 Comments

The recent move on the part of the Union Health Ministry to amend the Drugs and Cosmetic Rules 1945 through Schedule HX is creating a stir among chemists and pharmacists, who are opposed to it. Even for the medical profession, this amendment is not patient–friendly.

Under the Schedule HX, the drugs for TB (Rifampicin, Isoniazid and Pyrazinamide), Ciprofloxacin and Norfloxacin (for Diarrhea) and Framycetin (for burns) would no longer be as easily available as they are today.

The Schedule HX has Part A and Part B. And, according to it, 16 antibiotics in Part A would be sold directly by drug manufacturers to the tertiary care hospitals, and 74 drugs in Part B can be sold by the chemist only on the prescription of Registered Medical Practitioners in duplicate. The extra copy of the prescription would be kept with the chemist for a further 2 years.

The schedule talks about the need to have tertiary hospitals, registered medical practitioners and prescriptions in duplicate for the drugs in Schedule HX.

  1. There are no tertiary hospitals in the rural areas.
  2. Newer antibiotics are very costly and if they can only be prescribed in a tertiary care hospital, will people be able to afford these hospitals?
  3. ICU care in a tertiary hospital may cost 30-50,000 per day.
  4. Today many chemists offer hefty discounts on branded drugs as they play with margins of up to 40%. No tertiary care hospital will pass on this discount to the patient.
  5. A patient may have to be given antibiotic for weeks and most of this period may be ambulatory at home through a private nurse. Will the prescription be allowed from a tertiary care hospital pharmacy as an outpatient?
  6. Patients requiring these drugs invariably will be required to be transferred to a tertiary care hospital for the treatment. This may not be in the interest of the patient and the treating doctor.

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