English
Polski
Español
українська
Below are the 3 articles selected as suggested reading for this week by McMaster editors.
Please be advised that until the end of August Publications of the Week will be temporarily published in a less frequent, biweekly cycle.
Preventing early recurrences after TIA or ischemic stroke: the importance of aspirin
The benefit of acetylsalicylic acid (ASA) after ischemic stroke is maintained over long time, but it seems accrued in the very early and acute phase of stroke, where delay by hours may count. It is most pronounced among people with transient ischemic attack (TIA) or minor stroke. Authors postulate the value and need for early ASA administration similar to that in acute coronary events.
Prior to conducting this meta-analysis of individual patient data, authors postulated that the benefit of ASA observed in stroke trials (in relative terms, the risk was reduced by ~13%) underestimated early benefits of this intervention. Their findings suggest that risk of recurrent stroke is markedly decreased in the period from 0 to 6 weeks after randomization (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.32–0.55) with greatest benefit occurring in patients with minor stroke or TIA within the first 2 weeks of treatment (HR, 0.07; 95% CI, 0.02–0.31). After 12 weeks, the early benefit was maintained but no additional benefit was accrued (odds ratio [OR] for the period after 12 weeks, 0.97; 95% CI, 0.84–1.12). In contrast, adding dipyridamole to ASA had no major effect on early stroke recurrence (0–12 weeks, OR 0.90; 95% CI, 0.65–1.25) but noticeable effect was present thereafter (OR, 0.76; 95% CI, 0.63–0.92).
The effect of ASA was present very early: In patients randomized within the first 48 hours from stroke of minor to moderate severity or TIA, the risk was reduced by half on the second day of treatment (HR, 0.44; 95% CI, 0.25–0.76) with further reductions evident until day 14 and much less clear additional benefit after day 14. Those findings, according to authors, should have implications for the rapidity of assessment and treatment of stroke or TIA, up to the point of public education and self-administration of ASA when symptoms consistent with TIA or stroke of minor to moderate severity occur.
Obesity: effects of different pharmacological treatments
Out of 5 drugs approved by the US Food and Drug Administration for treatment of obesity, all are associated with a weight loss at 1 year, which ranged from a mean of 8.8 kg to 2.6 kg.
Over 29,000 patients with a median body mass index of 36.1 taking part in 28 randomized controlled trials were included in the network meta-analysis. At least 5% weight loss was achieved in 23% of patients given placebo versus 75% of patients taking phentermine-topiramate, 63% patients taking liraglutide, 55% taking naltrexone-bupropion, 49% on lorcaserin, and 44% on orlistat. The absolute weight loss varied from 8.8 kg (phentermine-topiramate), through 5.3 kg (liraglutide), 5.0 kg (naltrexone/bupropion), 3.2 kg (lorcaserin), to 2.6 kg (orlistat). Lorcaserin and orlistat were associated with the lowest probability of adverse events. Liraglutide (odds ratio [OR], 2.95; 95% credible interval [CrI], 2.11–4.23) and naltrexone-bupropion (OR, 2.64; 95% CrI, 2.10–3.35) were associated with the highest odds of adverse event-related treatment discontinuation.
Smoking cessation: gradual vs abrupt approaches
People wishing to quit smoking have a higher probability to succeed with abrupt rather than gradual (over 2 weeks’ time) smoking cessation.
Almost 700 participants (smoking at least 15 cigarettes/day) were randomly assigned to a program of gradual smoking reduction (50% by the end of week 1, 75% by the end of week 2 with stopping at that time) or immediate cessation. Nicotine replacement therapy (NRT) (nicotine patch 21 mg/day) was provided to all patients for a period of 2 weeks prior to the planned complete stopping time. Following the quit day, all patients were also provided with a choice of short-acting NRT products (gum, lozenges, nasal spray, sublingual tablets, inhalator, or mouth spray); such therapy was also provided to patients in the gradual reduction group during the 2-week period of decreasing nicotine consumption. All patients received behavioral support from nurses.
Four weeks after the quit day, the proportion of patients with confirmed abstinence was higher in the abrupt cessation group (49% vs 39%); after 6 months, the proportion was 22% versus 15.5%. Regardless of the assigned group, prior to the study patients were asked which method they preferred, and those who chose abrupt cessation had a higher chance of not smoking at week 4 (52% vs 38%). The overall rate of successful quitting remains low.
