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Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease

Low‐dose aspirin as antiplatelet therapy is still the drug of choice for preventing cardiovascular events, but the protection aspirin gives to people at high risk of cardiovascular events is only relatively modest. This review of 28,165 people in two trials where clopidogrel was given in addition to antiplatelet treatment found that in patients with acute coronary syndromes the benefit ‐ a reduction in cardiovascular events ‐ outweighs the harm of major bleeding. However, clopidogrel plus aspirin has no clear positive risk‐benefit profile in people at high risk of cardiovascular events (multiple atherothrombotic risk factors) or in people with established cardiovascular disease (known coronary disease, ischemic cerebrovascular disease or peripheral arterial disease) but not presenting with an acute coronary syndrome, and the combination should not be prescribed routinely to prevent cardiovascular disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Aspirin with or without an antiemetic for acute migraine headaches in adults

This is an updated version of the original Cochrane review published in Issue 4, 2010 (Kirthi 2010); no new studies were found. A single oral dose of 1000 mg of aspirin reduced pain from moderate or severe to none by two hours in approximately 1 in 4 people (24%) taking aspirin, compared with about 1 in 10 (11%) taking placebo. Pain was reduced from moderate or severe to no worse than mild pain by two hours in roughly 1 in 2 people (52%) taking aspirin compared with approximately 1 in 3 (32%) taking placebo. Of those who experienced effective headache relief at two hours, more had that relief sustained over 24 hours with aspirin than with placebo. Addition of 10 mg of the antiemetic metoclopramide substantially increased relief of nausea and vomiting compared with aspirin alone, but made little difference to pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia

Recurrent miscarriage is associated with inherited blood clotting disorders that could interfere with the placental blood circulation. Recurrent miscarriage can also be unexplained, with no known cause. Anticoagulant drugs such as aspirin or low molecular weight heparin may help women with recurrent miscarriage and such an underlying blood clotting problem. These drugs may also cause bleeding (including nose bleeds and haematomas) in the mother, though not in the baby. Data from nine included randomised controlled trials (involving 1228 women) analysed in this review, provided no evidence to support the use of anticoagulants in women with recurrent miscarriage, regardless of the presence of inherited blood clotting disorders (thrombophilia).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Non‐steroidal anti‐inflammatory drugs, including aspirin and paracetamol (acetaminophen) in people taking methotrexate for inflammatory arthritis

This summary of a Cochrane review describes what we know from research about any safety issues from using non‐steroidal anti‐inflammatory drugs, or NSAIDs, including aspirin, or paracetamol (acetaminophen), or both, along with methotrexate in people with inflammatory arthritis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Fixed‐dose combination drug therapy for the prevention of heart disease and stroke

Review question: We reviewed the evidence about the effect of fixed‐dose combination drug therapy on the prevention of heart attacks and strokes. We found 13 studies including 9059 participants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 6, 2017

Dipyridamole for preventing stroke and other vascular events in patients with vascular disease

Patients with symptoms of arterial disease have a high risk of getting a (possibly fatal) stroke or heart attack (myocardial infarction). Antiplatelet therapy with drugs like aspirin prevents blood clotting and reduces the risk of strokes, heart attacks, and death from vascular disease. Dipyridamole, another antiplatelet drug, given on its own or together with aspirin might reduce the risk even further. This review included 29 studies involving 23019 participants. When we compared the effects of dipyridamole (alone or together with aspirin) with aspirin alone there was no evidence of an effect on death from vascular causes. When we compared the effects on the occurrence of vascular events (strokes, heart attacks, and deaths from vascular diseases) the combination of aspirin and dipyridamole had an advantage over aspirin alone. This result holds particularly true for patients with ischaemic stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Anticoagulants versus antiplatelet agents for acute ischaemic stroke

Treatment with anticoagulants offers no net advantages over antiplatelet agents in patients with acute ischaemic stroke. Ischaemic stroke is caused by a blood‐clot blocking the blood supply to an area of the brain. Blood‐thinning drugs, such as anticoagulants and antiplatelet agents, can potentially prevent arteries from being blocked, or prevent them re‐blocking. They can also prevent clots forming in the deep veins in the leg, which can break off and travel to the lungs. However, such drugs can also cause bleeding complications, which might offset any benefits. Antiplatelet agents (mainly aspirin) are associated with long‐term benefits and have become standard treatment for acute ischaemic stroke. This review aimed to test whether any anticoagulant regimen offers net advantages over antiplatelet agents, overall, or in specific categories of patients. There was no evidence that anticoagulants are superior to antiplatelet agents (in fact, anticoagulants caused a small increase in the number of deaths at long‐term follow‐up). However, the combination of low‐dose anticoagulant and aspirin seemed to offer benefits over aspirin alone, and the combination should be investigated further.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Glycoprotein IIb‐IIIa inhibitors for acute ischaemic stroke

Question: We wanted to evaluate the safety and effectiveness of GP IIb‐IIIa inhibitors, alone or in combination with thrombolytic agents, in individuals with acute ischaemic stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant

Treatments for recurrent miscarriage when there are antibodies in the mothers blood.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antiplatelet therapy for preventing stroke in patients with non‐valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks

Antiplatelet agents like aspirin are effective for preventing serious vascular events in patients with atrial fibrillation not suitable for oral anticoagulants. Atrial fibrillation is an irregularity of the heartbeat that leads to blood clots forming in the upper chambers of the heart (the atria). These clots can break free and travel through the bloodstream to the brain and cause a stroke. Drugs that slow clotting, such as antiplatelet agents (aspirin and others) and anticoagulants reduce the risk of stroke in patients with atrial fibrillation. In this review the benefits of antiplatelet agents are shown to be modest (nearly 25% decrease in stroke), but they are relatively safe, easy to take, and therefore an important treatment option for many atrial fibrillation patients. Anticoagulation with warfarin and related drugs offers more protection against stroke (nearly two‐thirds reduction), but anticoagulant drugs can cause severe bleeding and require careful regulation with regular blood tests. The choice of antiplatelet drugs versus anticoagulants should be individualized based on the patient's inherent risk of stroke, ability to tolerate anticoagulation without bleeding, access to adequate anticoagulation monitoring, and patient preferences.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Adenosine‐diphosphate (ADP) receptor antagonists for the prevention of cardiovascular disease in patients with type 2 diabetes mellitus

Patients with type 2 diabetes have a much higher risk of strokes and heart attacks than the general population. Most strokes and heart attacks are caused by blood clots. Adenosine‐diphosphate (ADP) receptor antagonists are drugs which prevent the aggregation ('clumping') of platelets and consequently reduce the formation of blood clots. These medications are used to prevent cardiovascular disease such as heart attacks and strokes in the general population. This review assessed if these medications would be useful in patients with diabetes. We included eight trials with 21,379 patients and a mean duration of follow‐up ranging from 365 to 913 days. Specific data for patients with diabetes were only available in full for one of these trials and partial data were available for two trials. Analysis of the available data demonstrated that adenosine‐diphosphate receptor antagonists (such as clopidogrel, prasugrel, ticagrelor, ticlopidine) were not more effective than other blood thinning drugs or placebo for death from any cause, death related to cardiovascular disease, heart attacks or strokes. There was no available information on the effects of adenosine‐diphosphate receptor antagonists on health‐related quality of life, adverse effects specially for people with diabetes, or costs. The use of adenosine‐diphosphate receptor antagonists in patients with diabetes needs to be guided by the information available from trials which included patients with and without diabetes. All future trials on adenosine‐diphosphate receptor antagonists should include data which relate specifically to patients with diabetes in order to inform evidence‐based clinical guidelines.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antiplatelet agents and anticoagulants for hypertension

Daily aspirin reduces the incidence of heart attacks to a small degree, but increases the incidence of major bleeding events to a similar degree in patients treated for high blood pressure who have not had a prior stroke or heart attack. In patients with high blood pressure who have had a stroke or heart attack, the benefits of daily low‐dose aspirin outweigh the harms. There is no evidence of benefit for antithrombotic therapy with warfarin alone or in combination with aspirin in patients with high blood pressure. The benefits and harms of the newer drugs glycoprotein IIb/IIIa inhibitors, clopidogrel, prasugrel, ticagrelor and oral antithrombotic agents such as dabigatran and rivaroxaban for patients with high blood pressure have not been studied in clinical trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antithrombotic therapy for improving maternal or infant health outcomes in women considered at risk of placental dysfunction

Pregnancy complications such as pre‐eclampsia and eclampsia, intrauterine fetal growth restriction and placental abruption are thought to be related to abnormalities in the development and function of the placenta. Treatment with heparin to prevent the development of blood clots within the placenta appears to be a promising intervention to prevent these complications. The numbers of pregnant women with pre‐eclampsia, preterm birth, perinatal death and a low birthweight infant (weighing less than the 10th centile for gestational age) were reduced with this treatment. Ten randomised trials involving 1139 women met the inclusion criteria for the review. Nine studies compared heparin (alone or in combination with dipyridamole) with no treatment; and one compared triazolopyrimidine with placebo. The most commonly recognised side effect for women related to this treatment was mild skin bruising. To date, important information about serious adverse infant and long‐term childhood outcomes with using anti‐clotting medications is unavailable. Further research is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Interventions to treat erythema nodosum leprosum, a complication of leprosy

Leprosy remains a public health issue in poorer parts of the world. In 2007 there were approximately 255,000 new cases reported worldwide. Leprosy (or Hansen's disease) is a chronic infectious disease. The skin and peripheral nerves of people with leprosy contain leprosy bacteria. Leprosy can be cured with a combination of antibiotics. The immune system plays an important role in leprosy and determines if and how the disease will develop. The response of the immune system to the antigens of the leprosy bacteria may cause periods of inflammation in the skin and nerves, called reactions. Reactions are the main cause of acute nerve damage and disability in leprosy and occur in about one third of people with leprosy. One type of reaction is erythema nodosum leprosum (ENL), a serious and often chronic complication of leprosy caused by the immune system. People with ENL have red, painful swellings in the skin and often feel ill due to fever and general malaise. There are several treatments for ENL, including the oral drugs prednisolone, thalidomide, and clofazimine. We undertook a systematic review on this topic as it was not clear which treatments were most beneficial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Medication for migraines

Migraine attacks can be treated with painkillers or migraine medication. If needed, medicine for nausea and vomiting can be taken as well. But if painkillers are taken too often they themselves may cause headaches.Lying down in a dark, cool room may be enough to relieve mild migraines. Migraines are usually very painful, though, so most people take medication to get through them. Over-the-counter painkillers may be effective enough for moderate pain. Stronger medication is sometimes needed for severe migraines.  If you often have migraines, it is a good idea to have different kinds of medicine on hand.The following medications can be used to treat migraine:The group of painkillers known as NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen (paracetamol)Anti-nausea medication Special migraine medication (triptans and ergotamines)

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 19, 2015

Antiplatelet agents for preventing failure of peripheral arterial grafts

Symptomatic peripheral arterial disease in people with atherosclerosis can present as intermittent claudication, disabling pain on walking, or as critical limb ischaemia with pain at rest, ulceration, gangrene and the risk of losing a leg. One treatment option is to implant a graft or makeshift blood vessel to bypass a blockage in the main artery of the thigh. Using a section of the vein from the patient's leg is often better than artificial or prosthetic materials such as Dacron or polytetrafluoroethylene, which take up platelets that could lead to clotting that could block the graft. Other factors affecting the patency of the graft (how long the bypass remains open) include length of the bypass, site where the graft connects to the existing artery and blood flow out of the graft. Stenosis (narrowing) of the graft most frequently occurs at the surgical connections because of hyperplasia, or an increase in the number of smooth muscle cells, into the inner layer of the vessel, often followed by the formation of a thrombosis (clot) at the stenotic site.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Ticagrelor (trade name EU: Brilique, US: Brilinta) for people at high risk of a stroke or heart attack: Overview

Ticagrelor (trade name EU: Brilique, US: Brilinta) has been approved in Germany since February 2016 for adults who have had a heart attack at least a year ago and who are at high risk of having another heart attack or stroke.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 27, 2016

Using medication: The safe use of over-the-counter painkillers

Many painkillers are available from pharmacies without a prescription. They can provide effective pain relief, but might also cause side effects or complications. In order to use them safely, it is important to pay attention to the dose and interactions with other medicinal products.Over-the-counter painkillers available from pharmacies, such as ibuprofen or acetaminophen (paracetamol), can relieve acute pain. Their effectiveness will depend on things like the type and severity of the pain and the dose of the medication. Painkillers that are available without a prescription have been approved for the treatment of mild to moderate pain. They shouldn't be used for more than a few days in a row, and the specified maximum daily dose shouldn't be exceeded.Painkillers can have side effects and – in rare cases – lead to complications. In order to avoid adverse effects, it is important to make sure you use them properly. This is particularly true for people who have certain medical conditions or use painkillers regularly. A medication's package insert contains detailed information about its areas of use, the correct doses and how long you can use it for.  You can also ask your doctor or pharmacist about how to use it properly.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 6, 2016

Fever in children: How can you reduce a fever?

When children have a fever, they don't always need to be given medication to lower it. But it can be a good idea to treat the fever if they are feeling extremely unwell or the fever is very high.It isn’t always clear whether the child's symptoms are being caused by the fever or by an underlying illness. So lowering the fever won't necessarily make them feel better.There are basically two ways to lower a fever: using medication or applying a cooling treatment from outside the body Some parents hope that they will be able to prevent febrile seizures with medication. But there is a lack of good research on whether fever-lowering medication can actually prevent febrile seizures.Many parents also try homeopathic products, including aconitum D12, belladonna D12 or chamomilla D12. But there is no scientific proof that these homeopathic treatments are at all effective.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 17, 2016

Comparing NSAIDs

How do NSAIDs compare in reducing pain?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: May 1, 2011

Systematic Reviews in PubMed

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Systematic Review Methods in PubMed

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