Meta-analysis of empirical long-term antiarrhythmic therapy after myocardial infarction

Article Abstract:

Meta-analysis is a statistical method that allows individually executed research studies to be evaluated, by combining their data, to give a more meaningful and larger statistical sample of the population being studied. In this case, a group of studies was combined to evaluate the efficacy of giving long-term drug therapy to prevent irregular heart beats (arrhythmia) in a population of individuals who had previously had a heart attack (myocardial infarction). The rationale behind this work is that many former heart-attack victims die from "sudden death", an event in which the heart stops pumping blood effectively, often as a result of arrhythmia. From an initial list of 11 pertinent studies, 10 were included in the meta-analysis. The study included data taken from 4,122 patients who were either placed on an antiarrhythmic drug or given an ineffective placebo (control). Although this study meets newly proposed standards for meta-analysis, nine different antiarrhythmic drugs had been used. The final study demonstrates that treating patients who are at moderate risk for sudden death after myocardial infarction with anti-arrhythmic medications does not provide the patients with any advantage and, under some circumstances, the treatment itself could be lethal. Other studies have suggested, however, that there may be subpopulations that could derive benefit from anti-arrhythmic therapy.

Sudden death, Anti-arrhythmia drugs, Antiarrhythmia agents

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Meta-analytic evidence against prophylactic use of lidocaine in acute myocardial infarction

Article Abstract:

A myocardial infarction, or heart attack, occurs when the arteries supplying the heart muscle become blocked. This blockage decreases the blood supply to the muscle tissue and causes tissue death. Patients who have had a recent acute myocardial infarction (AMI) are at risk for developing ventricular arrhythmias, disorganized and inefficient heart beats that can cause death. These arrhythmias can be controlled with intravenous injections of the drug lidocaine. It is customary in coronary care units to give a prophylactic dose of lidocaine to all AMI patients. Aside from its beneficial effect, however, it is not known whether there are any adverse effects contributing to death from prophylactic lidocaine therapy. To determine whether this prophylactic lidocaine therapy affects mortality, patients from six prehospital studies (7,656 patients) and eight hospital studies (1,407 patients) were reviewed. Lidocaine therapy during the prehospital phase did not reduce mortality but did tend to increase mortality when given to uncomplicated AMI patients in a monitored hospital setting. Prophylactic lidocaine should therefore not be used in patients with proven or suspected AMI in monitored hospital units.

Health aspects, Patient outcomes, Mortality, Ventricular fibrillation, Xylocaine

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Endoscopic hemostasis: an effective therapy for bleeding peptic ulcers

Article Abstract:

Patients with actively bleeding ulcers of the stomach (gastric) or intestine (duodenal) may require surgery. A bleeding ulcer is examined with a flexible instrument called an endoscope. Hemostasis, the cessation of bleeding, and repair of blood vessels may be accomplished using lasers or sclerotherapy, injection of a solution that causes scarring or fibrosis of the ulcerous area. Reported cases of patients with bleeding ulcers treated with endoscopic hemostatic procedures were evaluated. Three variables were examined for each patient: the need for emergency surgery, in-hospital mortality (risk for death), and recurrence of bleeding. Endoscopic hemostasis produced significant reductions in the three end points when compared with non-invasive medical management. The need for emergency surgery and death rates can be reduced by treating actively bleeding patients. It was not clearly determined which method of endoscopic hemostasis is best; however, injection sclerotherapy may be the standard against which other treatments should be measured. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lasers in surgery, Laser surgery, Peptic ulcer, Endoscopic surgery, Stomach ulcer, Duodenal ulcer, Hemostasis, Surgical, Surgical hemostasis

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