Ischaemic heart disease

Clopidogrel should be given for one year after stenting ▸

Most cardiologists presently prescribe 2–4 weeks of clopidogrel after placing coronary stents. In patients with acute coronary syndromes, the CURE study suggests benefit to nine months, although most of the benefit was achieved in the first three days. The CREDO study suggests that one year of therapy may be appropriate. At one year, long term clopidogrel treatment was associated with a 26.9% relative reduction in the combined risk of death, myocardial infarction (MI), or stroke (95% confidence interval (CI) 3.9% to 44.4%; p =0.02; absolute reduction 3%). Clopidogrel pretreatment did not significantly reduce the combined risk of death, MI, or urgent target vessel revascularisation at 28 days (reduction 18.5%, 95% CI −14.2% to 41.8%; p = 0.23). However, in a prespecified subgroup analysis, patients who received clopidogrel at least six hours before percutaneous coronary intervention (PCI) experienced a relative risk reduction of 38.6% (95% CI −1.6% to 62.9%; p = 0.051) for this end point compared with no reduction with treatment less than six hours before PCI. Risk of major bleeding at one year increased, but not significantly (8.8% with clopidogrel v 6.7% with placebo; p = 0.07).

Cardioselective β blockers can be safely used in patients with asthma/COPD ▸

Randomised, blinded, placebo controlled trials that studied the effects of cardioselective β blockers on forced expiratory volume in one second (FEV₁), symptoms, and the use of inhaled β2 agonists in patients with reactive airway disease were selected for meta-analysis. Nineteen studies on single dose treatment and 10 studies on continued treatment were included. Administration of a single dose of a cardioselective β blocker was associated with a 7.46% (95% CI 5.59% to 9.32%) decrease in FEV₁ and a 4.63% (95% CI 2.47% to 6.78%) increase in FEV₁ response to β agonist compared with placebo, with no increase in symptoms. Trials lasting from three days to four weeks produced no …