Vioxx and the 140,000 MI’s

As I previously noted here, a study by Graham et al, examining the cardiovascular risks of Vioxx, was being considered for publication in the Lancet when it was prematurely published on the FDA’s website, much to the Lancet’s dismay. Today, that same study, with some modifications, has been published online at the Lancet. It is …

Aspirin vs. Plavix after upper GI bleeding

What a frustrating paper. In last week’s NEJM is a study from the Prince of Wales Hospital in Hong Kong looking at clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. More precisely, the authors studied patients who had been on 325 mg aspirin or less, who presented with upper GI bleeding and who …

Coronary revascularization before vascular surgery

Patients undergoing vascular surgery are at higher risk for cardiovascular events. Despite published guidelines, the exact approach to pre-operative cardiac evaluation for these patients varies significantly. The report of a VA cooperative study in last week’s NEJM looked at the value of prophylactic coronary-artery revascularization before elective major vascular surgery. Patients undergoing elective AAA repair …