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Your Article Summary Novel Anticoagulants for Atrial Fibrillation: A Critical Appraisal Angiology, 10/19/11 Tzeis S et al. – Recently completed phase III mega–trials of dabigatran, rivaroxaban and apixaban have provided cumulative evidence in favor of these novel anticoagulants. Their main advantages, apart from their treatment efficacy, include the reduced rate of intracranial hemorrhage, the lack of need for routine coagulation monitoring, the predictable anticoagulation response and the limited interaction with food and drugs. Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an increased risk of thromboembolic complications and stroke. Therefore, the implementation of thromboembolic preventive treatment is the cornerstone of quality management in AF patients. During the last 60 years, vitamin K antagonists remain at the forefront of antithrombotic management of AF patients. Randomized trials have demonstrated their superiority over aspirin as well as over the combination of aspirin and clopidogrel with similar safety profile. However, the disseminated use of vitamin K antagonists among suitable candidates is hampered by their inherent limitations. As a result, a considerable proportion of AF patients do not receive this life–saving therapy. In the last few years, novel anticoagulants targeting factors IIa (dabigatran) and Xa (rivaroxaban, apixaban, edoxaban) in the coagulation cascade have been developed.           Your Article Summary Oral manifestations of gastroesophageal reflux disease Journal of Gastroenterology and Hepatology, 10/21/11 Ranjitkar S et al. ? Proton pump inhibitors(PPIs) do not always result in adequate acid suppression. Therefore, collaboration between physicians and dentists is strongly advocated to prevent or ameliorate possible adverse oral effects from both endogenous and exogenous acids, and to promote adequate saliva production in patients with GERD. Numerous case–control and other studies involving confirmation of gastroesophageal reflux disease (GERD) by esophageal pH–metry and the assessment of dental erosions have shown significant associations between the two conditions in both adults and children. By contrast, when asked to vote on whether GERD may cause dental erosions, only 42% of physicians strongly agreed that such an association existed in adults, and just 12.5% strongly agreed for children, respectively in two global consensus reports. Part of this divergence between the perceptions of physicians and the findings of research publications may reflect a general lack of oral health education during medical training, and cursory oral examinations being made under less–than–ideal conditions. Adequate salivary secretions are essential for the protection of the teeth and the oropharyngeal and esophageal mucosa. Quantity and quality of the saliva require monitoring as many drugs, including several of the proton pump inhibitors (PPIs), can cause hyposalivation.           Your Article Summary Twelve months of nightly zolpidem does not lead to rebound insomnia or withdrawal symptoms: A prospective placebo-controlled study Journal of Psychopharmacology, 10/19/11 Roehrs TA et al. ? The objectives of this study was to assess in primary insomniacs the likelihood of experiencing rebound insomnia and a withdrawal syndrome on repeated placebo substitutions over 12 months of nightly zolpidem use. Methods Group of 33 primary insomniacs, without psychiatric disorders or drug and alcohol abuse, 32?65 years old, 15 men and 18 women, were randomized to take zolpidem 10 mg (n = 17) or placebo (n = 16) nightly for 12 months In probes during months 1, 4, and 12, placebo was substituted for 7 consecutive nights in both zolpidem and placebo groups NPSGs collected and Tyrer Bezodiazepine Withdrawal Symptom Questionnaires were completed on first 2 discontinuation nights Results Rebound insomnia was not observed on first 2 and seventh discontinuation nights and its likelihood did not increase over 12 months of nightly zolpidem use Some individuals did show rebound insomnia, approximately 30?40% of participants, but the percentage of ?rebounders? did not differ between placebo and zolpidem groups and did not increase across 12 months No clinically significant withdrawal symptoms on the Tyrer were observed on the discontinuation nights over the 12 months of nightly use Chronic nightly hypnotic use at therapeutic doses by primary insomniacs does not lead to rebound insomnia or withdrawal symptoms.           Your Article Summary Treatment of Dementia with Lewy Bodies and Parkinson's Disease Dementia Drugs & Aging, 10/11/11

Ballard C et al. – A significant proportion of Parkinson's disease dementia (PDD) / dementia with Lewy bodies (DLB) patients are responsive to levodopa, but care needs to be taken with anti–parkinsonian treatments because of their potential propensity to exacerbate neuropsychiatric symptoms, particularly hallucinations. Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) account for 10–15% of late onset dementias. Key treatment targets include cognitive and functional impairments, neuropsychiatric symptoms including intense and persistent visual hallucinations, and parkinsonism. Six–month, placebo–controlled randomized controlled trials (RCTs) of the cholinesterase inhibitor rivastigmine have indicated modest but significant benefits in cognition, function, global outcome and neuropsychiatric symptoms in both PDD and DLB. The evidence base for other cholinesterase inhibitors from RCTs is inconclusive. More recent RCTs with memantine in PDD/DLB patients indicate a benefit with regard to global outcome, with some suggestion of a specific benefit with respect to sleep disturbance. Given the risk of severe antipsychotic sensitivity reactions, antipsychotics should be avoided.