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Monday, November 26, 2012
Mild Concussion Isn't So Mild After All
I'll be the first to admit that I don't follow football nearly as closely as many friends do but as I read about Peyton Manning getting tested for a concussion in yesterday's USAToday, I couldn't help but think about a case control study published online prior to print in next month's Radiology in which the authors concluded that even mild traumatic brain injury (TBI), commonly referred to as a concussion, led to notable changes on functional magnetic resonance imaging correlating with post-traumatic symptoms such as depression, anxiety, fatigue & post-concussion syndrome as well as neurocognitive dysfunction.
This builds upon a research letter published earlier this month in JAMA in which the authors noted that soccer players who regularly head the ball but without having sustained a history of a concussion had alteration to their white matter compared to matched swimmers who are at very low risk for repetitive subconcussive head trauma. While I'm not ready to change the rules for playing a global sport, I do believe we need to start paying more attention to what we label as a "mild" concussion.
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The authors arrived at their conclusions by comparing 23 patients who had suffered mild TBI resulting in symptoms for 2 months after their injury to 18 age-matched healthy control subjects. What's scary, in my opinion, is that conventional imaging using CT or MRI typically shows a normal picture w/o any evidence of anatomic injury. Yet this study shows that physiologically, there is tremendous impact (no pun intended) from even mild TBI.
This builds upon a research letter published earlier this month in JAMA in which the authors noted that soccer players who regularly head the ball but without having sustained a history of a concussion had alteration to their white matter compared to matched swimmers who are at very low risk for repetitive subconcussive head trauma. While I'm not ready to change the rules for playing a global sport, I do believe we need to start paying more attention to what we label as a "mild" concussion.
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Sunday, November 25, 2012
New Oral Anticoagulants: Ready for Prime Time?
Far be it for me to question the Food & Drug Administration regarding their decision over a year ago to approve two new oral anticoagulants for use in preventing stroke in atrial fibrillation. But as I noted last week, a study was just published in the Archives of Internal Medicine concluding that these new oral anticoagulants increased risk of bleeding in patients prescribed anti-platelet agents in response to an acute coronary syndrome.
Why the difference? This time, the authors analyzed data from 9 studies comprised of 16,701 participants regarding effectiveness and 16,611 regarding safety when used for treatment of acute venous thromboembolism and prevention of same. In fact, use of rivaroxaban was associated with lower risk of bleeding.
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As you know, life isn't always that simple & clear cut as a study was published last week in the British Medical Journal in which the authors concluded that these very same new oral anticoagulants did not increase risk of bleeding compared to traditional vitamin K antagonist while demonstrating similar event reduction & all-cause mortality when used to treat acute venous thromboembolism.
Why the difference? This time, the authors analyzed data from 9 studies comprised of 16,701 participants regarding effectiveness and 16,611 regarding safety when used for treatment of acute venous thromboembolism and prevention of same. In fact, use of rivaroxaban was associated with lower risk of bleeding.
Bottom line: assuming one survives the wallet biopsy, these new oral anticoagulants are safe for use in treating DVT but not in preventing same in the immediate post-ACS period of time while taking an anti-platelet agent, too. Ah, the devil is in the details.
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