Antiplatelet (usually aspirin) and anticoagulant (usually warfarin) treatments are available to reduce the risk of stroke in patients with atrial fibrillation (AF) but both have potentially harmful adverse effects and warfarin can be time-consuming and expensive to monitor. Guidance exists for choosing between treatments but is often insufficiently detailed to support an informed choice about the risk and benefits. Prescribers and patients are often left with a choice between aspirin or warfarin, and aspirin – which is perceived to be safer and easy to use – is often chosen. This article explores the evidence for aspirin and warfarin in preventing stroke in patients with AF, and describes how we should change the way that decisions about treatment are made.
Hypertension (high blood pressure) is estimated to affect 60-70% of people aged over 60 years of age and increases the risk of complications such as coronary heart disease, heart failure and stroke. Although it is well accepted that lowering blood pressure is crucial in reducing overall cardiovascular morbidity and mortality, the number of people whose raised blood pressure is reduced below target levels remains defiantly low. In this article, we review why so many patients fail to reach blood pressure targets and how we can improve this, including use of more than one antihypertensive.
The mechanisms underlying HF are complex and involve the interaction of many hormonal and molecular signalling pathways. These pathways form the basis of many pharmacological treatments, old and new. This article will examine the factors associated with the development of HF, the pathophysiology behind it and the neurohormonal pathways involved in established HF.
Varenicline (Champix) is the newest, prescription-only oral drug we have to treat patients with today's most important preventable health risk – smoking. With the 1st July deadline for no smoking in public places, there is more reason than ever for people to quit. NICE has recommended use of varenicline by the NHS in recent draft guidance, alongside counselling and support. In this article, we review how the drug fits into our strategies for helping our patients to stop smoking.
General practices are under increasing pressure to initiate insulin in type 2 diabetes, as it would be more efficient for the health service and more convenient for most patients. There are many different approaches to starting insulin, but it is essential for practice nurses to work closely with patients and progress slowly to ensure successful and safe outcomes.
We often take modern medicine for granted,but a review of the history of a disease and its treatment can help us put the whole thing in perspective.In this article,we trace the development of understanding about the nature and cause of diabetes and the use of insulin as a key treatment.
Although there are other oral anticoagulation agents available, warfarin is the drug used predominantly in the UK. Warfarin has been in clinical use for over 50 years. It is still referred to by patients as 'rat poison' and,indeed, warfarin derivatives are still used as rodenticides.In this article, we take a look at some of the new oral anticoagulants coming along.
The US National Institute of Health (NIH) has launched an App providing research-based information about the safety and effectiveness of herbal products. HerbList™ provides rigorously researched scientific information to provide consumers and health care practitioners with unbiased information to make informed decisions about supplement use.