Need For Non-steroidal Anti-inflammatory Drugs Research Articles

The use of chondroitin sulfate (Mucosat) for the treatment of chronic back pain and osteoarthritis

The representation of pain syndromes of various localization is very extensive: in the knee and hip joints, this figure reaches 57,8% of the general population, in the shoulder joint 48–84%, and pain in the lower back is experienced by up to 85%. The prevalence of osteoarthritis (OA) increases with age. OA occupies a leading position among all rheumatological diseases, accounting for more than 60–70 % of their total number, and is the leading cause of chronic pain syndrome in the older age group. Clinical symptoms of OA are observed in 30–50% of the population in people over 65 years. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs for the treatment of pain syndromes. NSAIDs are characterized by a good analgesic effect, but are often the cause of the development of adverse events (NSAIDS). Alternative for the treatment of degenerative-dystrophic lesions of the joints is chondroprotectors (CP). CPS belong to the group of drugs of delayed action of symptomatic therapy (SYSADOA). Among CP, chondroitin sulfate (CS) is considered to be the most acceptable means that can affect metabolic processes in cartilage, synovial and bone tissue, suppressing the synthesis of proinflammatory mediators. The main effects that CS has on the joint in OA are: anti-inflammatory, analgesic, and protective. CS improves the phosphorus-calcium metabolism in cartilage, inhibits enzymes that violate the structure and function of articular cartilage, inhibits the degeneration of cartilage; stimulates the synthesis of glycosaminoglycans (GAG), normalizes the metabolism of hyaline tissue, promotes the regeneration of cartilage surfaces and the articular bag. The main effects that show CS on the joint in OA: anti-inflammatory, analgesic, protective. Slowing bone resorption, reduces the loss of Ca2+ and accelerates the processes of bone repair, inhibits the progression of OA. It has analgesic effect, reduces joint pain, pain at rest and when walking, the severity of inflammation, reduces the need for non-steroidal anti-inflammatory drugs (NSAIDs). One of the representatives of medicinal products based on CS is Mucosate (ampoules 1 and 2 ml) containing 100mg of CS in 1ml. A number of studies have demonstrated the effectiveness of therapy with Mucosat in the treatment of patients with low back pain (LBP) using the 2 ml intramuscularly every other day, a course of 25 injections, as well as in the treatment of OA using the 1 ml intramuscularly every other day, starting with the 4th injection – 2 ml every other day, also a course of 25 injections. Recent developments – a new oral form of Mucosate (capsule) containing harpagophytum and the NEM® complex can serve as a supplement to the injectable course of therapy.

Evaluation of the efficiency and safety of magnet therapy for osteoarthritis. Results of the multicenter blind placebo-controlled study COSMO (Clinical Evaluation of Current Magnet Therapy for Osteoarthritis)

Magnet therapy (Mt) is a well-known physiotherapy technique that is widely used to treat knee osteoarthritis (OA). Objective: to determine the efficiency and safety of Mt for knee OA. Subjects and methods. A study group consisted of 231 patients with knee OA (77.9% were women; mean age, 61.9+12.2 years; body mass index, 30.6+5.8 kg/m2; median disease duration, 5.0 [2, 0; 10.0] years). The patients were randomly assigned to two groups. Group 1 patients received Mt with an ALMAG+ device for 14 days; Group 2 had false Mt with a completely imitating ALMAG+ device that failed to create a magnetic field. The investigators evaluated the changes of the WOMAC index, pain intensity at rest and during movement on a 100 mm visual analogue scale (VAS), the need for nonsteroidal anti-inflammatory drugs (NSAIDs), and the degree of improvement, as assessed by patients (on a 5-point scale). Results and discussion . During the therapy, there was a statistically significant pain and stiffness reduction and functional improvement. Thus, there were decreases in the median WOMAC pain scores from 231 [180; 290] to 110 [60; 166.3] (p<0.001) in Group 1, from 212.4 [145; 260] to 143 [76.5; 200] (p<0.001) in Group 2, in pain intensity at rest from 47 [27.8; 60] to 20 [10; 30] mm (p<0.001) in Group 1; from 40 [20; 57.5] to 20 [7.5; 40] mm (p<0.001) in Group 2. During the therapy, there was also a reduction in the need for NSAIDs: the drug was discontinued or its dose reduced in 33.1% and 16.8% of the patients in Groups 1 and 2, respectively (p=0.006). The changes of all parameters were statistically more significant in Group 1 than in Group 2. Treatment results were assessed as good and excellent by 58.5% and 39.8% patients in Groups 1 and 2, respectively (p<0.001). No serious adverse events to true and false Mt were observed. Therapy was discontinued due to increase of joint pain in two patients who received false Mt. Conclusion. Short-term Mt provides a significant improvement in patients with knee OA. Mt is well tolerated and causes no serious complications.

Prescription of chondroitin sulfate in back pains

One of the promising areas of pharmacotherapy in degenerative-dystrophic lesions of the joints, such as osteoarthritis (OA), is the use of chondroprotectors (CP). CPs belong to the group of Symptomatic Slow Acting Drugs for OsteoArthritis (SYSADOA). Among CPs, chondroitin sulfate (CS) is considered to be the most acceptable means capable of influencing metabolic processes in cartilage, synovial and bone tissue, suppressing the synthesis of proinflammatory mediators. CS improves phosphorus-calcium metabolism in cartilage tissue, inhibits enzymes that violate the structure and function of articular cartilage, inhibits the degeneration of cartilage tissue; stimulates the synthesis of glycosaminoglycans (GAG), normalizes the metabolism of hyaline tissue, promotes regeneration of cartilage surfaces and articular bags.The main effects that show CS on the joint in OA: anti-inflammatory, analgesic, protective. Slowing bone resorption, reduces the loss of Ca2+ and accelerates the processes of bone repair, inhibits the progression of OA. It has analgesic effect, reduces joint pain, pain at rest and when walking, the severity of inflammation, reduces the need for non-steroidal anti-inflammatory drugs (NSAIDs). The appointment of correctors of bone and cartilage metabolism is indicated at any stage of the degenerative process in the joints. One of the medicinal product (MP) based on CS is Chondroitin-ACOS (capsules, 25mg), whose effectiveness in the treatment of patients with OA has been demonstrated in a number of studies. Dosage Chondroitin-ACOS: 0,75 g 3 times a day for 3 weeks, then 0,5 g 2 times a day for 9 weeks. The therapeutic effect develops after 8-12 weeks of taking the drug. Within one month after discontinuation of Chondroitin-ACOS, its aftereffect persisted. Chondroitin-ACOS can be recommended for patients with severe pain syndrome, radiologically confirmed OA I-III stages of different localization.

Effectiveness of various methods of cryotherapy in patients with osteoarthritis

We examined 150 patients with II - IV stage osteoarthritis of the knee and hip joints, movement pain of more than 40 mm on a VAS and Leken index more than 9. 120 of these patients received a course of CT of various temperatures and cryo-SMC for 2 weeks: 1st group (n=30) - CT of ice 0 °C; 2nd group (n=30) - cryo-SMC; 3rd group (n=30) - ACT; 4th group (n=30) - HC. The 5th group (control) included patients (n=30) who received only non-steroidal anti-inflammatory drugs (NSAIDs). We assessed dynamics of rest and movement pain according to VAS, the WOMAC index, the effectiveness according to the OMERACT-OARSI criterion and the need for NSAIDs. Effectiveness of treatment was evaluated by the patient and the doctor. OMERACT-OARSI analysis demonstrated a high percentage of CT response. A statistically significant decrease in rest and movement pain intensity was registered in all patients of the groups: ice 0 °C, cryo-SMC, ACT, HC and control groups. The pain decreased by 82-83% in the groups 1-4, and by 70% in the control group. There were no differences in the effectiveness of treatment between groups 1, 3, and 4 and the cryo-SMC group; effectiveness of treatment was statistically significant (p<0.01) between groups 1-4 and the control group. A statistically significant decrease in the total WOMAC index, as well as in «pain» and «stiffness» VAS subscales (p<0.01) in the absence of intergroup differences in the 1st, 3rd, 4th groups and the cryo-SMC (p>0.05) group and a statistically significant difference between the 1st-4th groups and the control group (p<0.01). According to the «function» subscale of the WOMAC index, a statistically significant difference between all groups was not found (p>0.05). Results of this study according to the OMERACT-OARSI effectiveness evaluation criteria indicate the comparability of CT as a treatment method with NSAID therapy in terms of the effect on improving the patient's functional capabilities and greater CT efficiency in relieving pain and stiffness in the joints.

Regular use of acetaminophen or acetaminophen–codeine combinations and prescription of rescue therapy with non-steroidal anti-inflammatory drugs: a population-based study in primary care

Objective: There are contrasting positions concerning the benefit–risk ratio of acetaminophen use for osteoarthritis (OA)-related pain. To clarify the effectiveness of acetaminophen or acetaminophen–codeine combinations according to their regimen of use, we evaluated whether being a regular user (adherent) of these medications decreased the occurrence of rescue therapy with non-steroidal anti-inflammatory drugs (NSAIDs).Methods: Using the Health Search IMS Health Longitudinal Patient Database, we formed a cohort of patients aged ≥18 years and newly treated with acetaminophen or acetaminophen–codeine combinations for OA between 1 January 2001 and 31 December 2013. These patients were followed up for one year in which they were categorized as regular or irregular users of these medications according to a variable medication possession ratio (VMPR) ≥ 50% or lower. We operationally defined the rescue therapy as the use of any NSAIDs prescribed for OA-related pain.Results: Overall, 40,029 patients (69.5% females; mean age: 68 ± 13.57) treated with acetaminophen or acetaminophen–codeine combinations formed the cohort. After the first year of treatment, regular users showed a statistically significantly lower risk of being prescribed with rescue therapy with NSAIDs (OR = 0.89; 95% CI 0.84–0.96).Conclusion: These findings show that regular use of acetaminophen or acetaminophen–codeine combinations may reduce the need for NSAIDs to treat OA-related pain.

CLINICAL EFFICACY OF RIZENDRONATE ACID IN THE COMPLEX THERAPY OF PATIENTS WITH OSTEOARTHRITIS AND METABOLIC SYNDROME

Objective : to assess the impact rizendronate acid on clinical and laboratory flow pattern of osteoarthritis in patients with the metabolic syndrome. Material and methods : the study included 50 patients with osteoarthritis and metabolic syndrome, which on the background of pathogenetic therapy received rizendronate acid at 35 mg per week during the year. Patients were evaluated indicators of inflammatory activity (ESR, CRP, TNF-α). The severity of articular syndrome was interpreted on a scale in rest and during movement, Lequesne index and WOMAC initially and after 3, 6 and 12 months. Mineral bone density (BMD) was assessed at lumbar spine by carrying out dual energy x-ray absorptiometry. Results : among patients receiving rizendronate acid was recorded a significant decline in CRP, ESR, TNF-α, positive changes in the indicators of the articular status – a significant reduction in the severity of pain at rest and in motion, decrease in Lequesne and WOMAC indexes, the trend of increase in BMD, while reducing the need for non-steroidal anti-inflammatory drugs. Conclusions : the use of risendronate acid in the complex therapy of patients with osteoarthritis with metabolic syndrome allows to achieve the reduction of the intensity of inflammation, the severity of pain while reducing the need for non-steroidal anti-inflammatory drugs.

Efficacy and safety of diacerein in patients with knee osteoarthritis

Diacerein (D) belongs to a class of symptomatic slow-acting agents, has an original mechanism of action, and is widely used as a diseasemodifying antirheumatic drug to treat osteoarthritis (OA) in Russia and many countries of the world. The ability of the drug to affect the main symptoms and progression of OA has been shown in a number of well-organized clinical trials. Objective: to evaluate the efficacy and safety of D in patients with knee OA. Patients and methods . An open-label trial evaluating the efficacy and safety of D (diaflex) in patients with knee OA was conducted in accordance with the multicenter program «Osteoarthrosis: Assessment of Progression in Real Clinical Practice». The trial included 80 patients of both sexes with Stage II–III knee OA; mean age, 60.8±6.8 years (47–75 years); mean body mass index, 31.8±5.9 kg/m2; disease duration, 10.3±5.7 years (2–30 years). The duration of the trial was 9 months (6 months of therapy and 3 months of follow-up). Results . There was a statistically significant reduction in visual analog scale pain on walking just 1 month after therapy initiation (57.1±9.7 and 44.7±13.9 mm; p<0.0001) and a further significant improvement throughout the 6-month therapy. Pain did not increase after the drug was discontinued (the follow-up period was 3 months). The same pattern was observed in the assessment of the WOMAC index (pain during early therapy, 243.8±73.9; pain at the end of therapy, 137.5±78.9; stiffness, 97.8±41.1 and 57.7±38.6; functional failure, 875.8±250.4 and 525±305.7 respectively; p<0.0001). Statistically significantly improved quality of life indicators measured by EQ-5D were noted throughout the follow-up period: 0.43±0.23 at the beginning of therapy, 0.61±0.14 at its end, and 0.63±0.11 at 3 months following treatment completion (p<0.0001). By the time of therapy completion, 71.3% of the patients completely refused to take nonsteroidal anti-inflammatory drugs (NSAIDs). Both the patient and the physician evaluated the efficiency of treatment identically. By the end of therapy, 87.5% of the patients were observed to have improvement. Adverse reactions (ARs) were recorded in 10 (12.5%) patients and mainly associated with more frequent stools; ARs were not a cause of treatment interruptions or protocol deviations. Conclusion. Diaflex has a good symptomatic and anti-inflammatory effect: the therapy statistically significantly reduces pain, stiffness, and the need for NSAIDs and improves quality of life and joint function. The drug has a good safety profile and after-effects, which is seen at least 3 months after therapy discontinuation.

The Last 10 Days of Patients With Glioblastoma: Assessment of Clinical Signs and Symptoms as well as Treatment.

High-grade gliomas are the most frequent primary brain tumors. Despite improvement in diagnostics and treatment, survival is still poor and quality-of-life issues are of major importance. Little is known regarding the clinical signs and symptoms of dying patients with glioblastoma. The aim of this study was to investigate signs and symptoms as well as therapeutic strategies in patients with glioblastoma in the end-of-life phase in order to improve end-of-life care. In this prospective single-center study, clinical data were obtained using a standardized protocol. We descriptively analyzed signs, symptoms, and therapeutic strategies on a daily basis. A total of 57 patients, who died due to glioblastoma in a hospital setting, were included. The most frequent signs and symptoms in the last 10 days before death were decrease in level of consciousness (95%), fever (88%), dysphagia (65%), seizures (65%), and headache (33%). Concerning medication, 95% received opioids. There was a high need for nonsteroidal anti-inflammatory drugs (77%) and anticonvulsants (75%). Steroids were given to 56%. Due to a decrease in level of consciousness and cognitive impairment, assessment of clinical signs and symptoms such as headache at the end of life is difficult. Based on the signs and symptoms in the last days before death in patients with glioblastoma, supportive drug treatment remains challenging. Our study emphasizes the importance of standardized guidelines for end-of-life care in patients with glioblastoma.

NOVEL APPROACHES TO TREATING NONSPECIFIC LOW BACK PAIN

Objective: to evaluate the impact of therapy with chondroitin sulfate (CS) and glucosamine (GA) on the clinical manifestations of low back pain (LBP). Subjects and methods. A multicenter open-label observational prospective study was conducted in 22 cities of Russia (46 centers) to investigate the efficacy of a combination of CS and GA in the outpatient treatment of nonspecific LBP. A total of 9761 patients were enrolled in the study that was completed by 8546 patients. Therapeutic efficiency was evaluated from changes in pain intensity during movement and at rest, by using the visual analogue scale. The Oswestry disability index, an global physician and patient assessment of therapeutic efficiency, and a daily need for nonsteroidal anti-inflammatory drugs (NSAIDs) were taken into account as additional criteria for efficiency evaluation. Results and discussion. The multicenter open-label observational study established the efficacy of a combination of CS and GA in treating nonspecific LBP: relief in pain during movement and at rest, functional improvement, and a reduction in the daily need for NSAIDs. The patients and physicians highly assessed therapeutic efficiency. The combination of CS and GA was also noted to be well tolerated. The findings may suggest that this combination may be a promising tool to treat LBP and gives proof to the expediency of its use in randomized placebo-controlled studies.

Jidabokuippo use in patients with fractures of the extremities

Abstract Aims Jidabokuippo (JDI) is a traditional Japanese medicine used for alleviating contusion-induced swelling and pain. Usually, nonsteroidal anti-inflammatory drugs (NSAIDs) are used for the treatment of swelling and pain associated with fractures of the extremities. However, one disadvantage of NSAIDs use is their potential to cause gastrointestinal problems, even in patients concomitantly treated with anti-ulcer drugs. In this study, we assessed the effectiveness of JDI in patients with fractures of the extremities. Methods Fifty patients (15 men and 35 women) with fractures of the extremities were recruited into the study. All participants were treated using non-invasive methods and administered JDI alone within 3 days of injury. The effectiveness of JDI was assessed following administration by evaluating the need for NSAIDs or other medication. In addition, adverse reactions were monitored. Results Comorbidities were present in 42% of the study participants. The mean duration of treatment was 9.9 ± 6.7 days (range 1–35 days). Forty-four patients did not require any medication other than JDI, testifying to its effectiveness. Five participants had their medication switched to NSAIDs, and one patient had eppikajutsuto added to the JDI treatment. In summary, 90% of the patients were effectively treated with traditional Japanese medicines. No adverse reactions were observed. Conclusion This study suggests that JDI can be used more widely for fractures of the extremities.

Combination pulse therapy with methotrexate and dexamethasone in patients with early rheumatoid arthritis and poor prognostic factors: an open-label randomized trial

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Mouth-Opening Exercise and Patient Control Use of NSAIDs: Preliminary Study of Disk Displacement without Reduction

Objectives: Our previous randomized study showed mouthopening exercises with nonsteroidal anti-inflammatory drugs (NSAIDs) therapy to be effective for temporomandibular joint (TMJ) pain and trismus in cases of disk displacement without reduction [1]. The purpose of this study is to determine whether mouth-opening exercises alone without NSAIDs can improve TMJ pain and trismus and to identify which patient requires supplemental administration of NSAIDs during treatment. Methods: Eighty patients with unilateral TMJ pain and trismus were instructed to perform mouth-opening exercises under a patient controlled use of NSAIDs for 1 week. The patients who took NSAIDs were compared with those who were treated with TMJ exercises alone. Results: Out of the 80 patients who performed mouth-opening exercises, 19 (24%) took NSAIDs while the remaining 61 patients (76%) did not take any pain medications. Two of the patients who took analgesics complained of stomach pain. It was noted that patients had reduced pain with mandibular movements and regained normal function during the study. Significant improvement on maximum mouth opening and quality of life was observed on both groups of patients. Improvement rate in patients who took NSAIDs were higher (37%) than those who did not (26%). Patients with smaller maximum mouth opening significantly took pain medications. Degree of pain on chewing before and after treatment was significantly larger in patients who took NSAIDs than those who did not. However, in total only 23 out of the 80 patients (29%) improved based on the classification of TMJ dysfunction criteria for one week. Conclusions: This study showed that mouth-opening exercises alone can improve TMJ pain and trismus but the need for NSAIDs was unavoidable in cases where symptoms were severe. The treatment regimen of mouth-opening exercises and minimal NSAIDs administration is recommended as a primary treatment for patients with TMJ pain and trismus in cases of disk displacement without reduction. More invasive secondary treatment is recommended for the patients who do not improve after the initial primary treatment.

NSAID GASTROPATHY: CHANGES OVER 12 YEARS

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Phytalgic®, a food supplement, vs placebo in patients with osteoarthritis of the knee or hip: a randomised double-blind placebo-controlled clinical trial

IntroductionThe medicinal treatment of osteoarthritis (OA) is mostly symptomatic to relieve pain and incapacity with analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), drugs with well-known risks. Complementary medicines might reduce the symptoms of OA and decrease the need for NSAIDs. This study tested the effects of a food supplement, Phytalgic®, on pain and function in patients with osteoarthritis and their use of analgesic and NSAIDs.MethodsA randomized double-blind parallel-groups clinical trial compared Phytalgic® (fish-oil, vitamin E, Urtica dioica) to a placebo for three months, in 81 patients with OA of the knee or hip using NSAIDs and/or analgesics regularly. The main outcome measures were use of NSAIDs (in Defined Daily Doses per day - DDD/day) or analgesics (in 500 mg paracetamol-equivalent tablets per week (PET/week) measured each month, and Western Ontario-McMaster University Osteo-Arthritis Index (WOMAC) function scales.ResultsAfter three months of treatment, the mean use of analgesics in the active arm (6.5 PET/week) vs. the placebo arm (16.5) was significantly different (P < 0.001) with a group mean difference of -10.0 (95% CI: -4.9 to -15.1). That of NSAIDs in the active arm (0.4 DDD/day) vs the placebo arm (1.0 DDD/day) was significantly different (P = 0.02) with a group mean difference of - 0.7 DDD/day (95% CI: -0.2 to -1.2). Mean WOMAC scores for pain, stiffness and function in the active arm (respectively 86.5, 41.4 and 301.6) vs the placebo arm (resp. 235.3, 96.3 and 746.5) were significantly different (P < 0.001) with group mean differences respectively of -148.8 (95% CI: -97.7 to -199.9), -54.9 (95% CI: -27.9 to -81.9) and -444.8 (95% CI: -269.1 to -620.4).ConclusionsThe food supplement tested appeared to decrease the need for analgesics and NSAIDs and improve the symptoms of osteoarthritis.Trial registrationClinicaltrials.gov NCT00666523.

Pycnogenol supplementation reduces pain and stiffness and improves physical function in adults with knee osteoarthritis

Knee osteoarthritis (OA) is a common degenerative joint disorder and a major cause of pain and disability. The purpose of this study was to investigate the potential effect of Pycnogenol (Horphag Research, Ltd, Geneva, Switzerland), a flavonoid-rich dietary supplement, on the symptoms of knee OA. Thirty-seven osteoarthritic patients were enrolled in a randomized, double-blind, placebo-controlled trial with parallel-group design. Patients received either placebo or Pycnogenol pills (50 mg, three times daily) in a blinded fashion for 3 months. Osteoarthritis clinical symptoms were evaluated monthly with Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. Nonsteroidal anti-inflammatory drugs (NSAIDs) or selective cyclooxygenase 2 (COX-2) inhibitors usage was also assessed. In the Pycnogenol group, there was a significant improvement in total WOMAC score and WOMAC subscale score of pain and physical function at 60 and 90 days of treatment. At 90 days, significant reduction of 43%, 35%, 52%, and 49% in self-reported pain, stiffness, physical function, and composite WOMAC score, respectively, were reported in Pycnogenol group, whereas the placebo group showed no significant changes. The dosage and frequency of NSAIDs or COX-2 inhibitors usage were increased in placebo group, which were significantly less in Pycnogenol group. The results of this study indicate the efficacy of Pycnogenol in alleviating osteoarthritis symptoms and reducing the need for NSAIDs or COX-2 inhibitors administration. This beneficial effect of Pycnogenol might be due to its antioxidant and anti-inflammatory properties. Further research is warranted to determine the underlying mechanism associated with this apparent effect.

Moderne konservative Arthrosetherapiekonzepte in der Praxis

Conservative treatment options for patients with degenerative arthritis have changed over the past decade. Subjective recommendations in the past were converted to evidence-based guidelines, especially due to the work of the European League Against Rheumatism (EULAR). In the first place are changes in patient lifestyle, which unfortunately take place only in the minority of patients. The use of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) as well as hyaluronic acid has increased over the last years. Both have been shown to be effective in evidence-based studies. Glucosamine and chondroitin sulfate have proved to be effective if they are used at an adequate dosage and for an appropriate time interval (at least 3 months). A special advantage seems to be that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) can be reduced. The positive effect of hyaluronic acids has recently been demonstrated by a Cochrane study; hyaluronic acids have a positive effect in early and midstage degenerative arthritis. The use of hyaluronic acids can also reduce the need for NSAIDs.

Warfarin use among patients with atrial fibrillation.

Warfarin reduces the rate of stroke among patients with atrial fibrillation. We sought to determine warfarin use within a population sample of elderly patients with atrial fibrillation. The Connecticut Peer Review Organization conducted a chart review of Medicare patients aged > or = 65 years with a history of atrial fibrillation before a hospitalization during the first 6 months of 1994. Among 488 patients (308 women; 457 white; 173 aged > or = 85 years), 38% (184/488) had a relative contraindication to anticoagulation (history of bleeding, dementia, alcohol use, falls, cancer, or the need for nonsteroidal anti-inflammatory drugs). Among the remaining patients (with known atrial fibrillation, but without a contraindication), only 38% (117/304) had been prescribed warfarin. Of those not prescribed warfarin, 63% (117/187) were also not taking aspirin. There were 272 patients with at least one additional vascular risk factor and no contraindication to anticoagulation. Among these patients at moderate to high risk for stroke, anticoagulation had been prescribed in 40% (109/272). Overal, among those not prescribed warfarin, 58% (95/163) were not taking aspirin. Patients admitted with a stroke were more likely to be significantly underanticoagulated (with international normalized ratio < 1.5) (43.5% versus 20.9% for those without stroke; P < .005). Anticoagulation was most effective for those with an international normalized ratio > or = 2.0. Warfarin anticoagulation with atrial fibrillation, even among "ideal" candidates, appears dramatically underutilized. In addition, among those prescribed warfarin, patients are often undertreated. Increased warfarin use among patients with atrial fibrillation represents an excellent opportunity for stroke prevention in the elderly.

Baillie's volute springs

The ongoing opioid crisis highlighted the need for non-steroidal anti-inflammatory drugs (NSAIDs), nonaddictive analgesics against pain, fever, and inflammation. However, NSAIDs may cause gastrointestinal and cardiovascular adverse effects. To avoid systemic toxicity and deliver drugs to diseased tissues, nanotechnology methods of NSAID encapsulation have been reported and some have reached clinical development. Currently, 57 micro- and nanodrugs are approved by the US FDA. Already approved nanoanalgesics have revealed superior efficacy or reduced toxicity compared with placebo or lower doses of systemically administered active comparators. In this review, the evidence for approval of the marketed nanodrugs will be discussed, with a focus on therapies for pain and inflammation. Nanomedicine remains an attractive field for the development of targeted analgesics.