Thread by @Drug_Evidence

THREAD: Dr. John Mandrola: “The more you see, the harder the medicine gets”

1/7 Some new views on legacy prescriptions: Beta-blockers, ASA & #statins by Dr. John Mandrola

(based on @drjohnm presentation hosted by @drug_evidence Oct 17, 2020: bit.ly/32fsPiA)

#MedED

2/7 Example 1: Beta blockers in heart failure 💊♥️

Observational studies suggest beta-blockers for heart failure tx beyond 3 years are NOT associated with beneficial outcomes 😯

These findings challenge current recommendations: bit.ly/3acX9P7

#MedEd #deprescribing

3/7 Ex. 2: How about beta blockers to treat MIs, looking at research from pre-reperfusion & reperfusion eras?

Large meta-analysis of about 60 trials, with > than 100,000 pts found NO difference from using beta blockers in the reperfusion era: bit.ly/3dfvn6u

#MedEd

4/7 Ex. 3: ASA story changed in 2018 with the ARRIVE trial 📰

12,500 pts with moderate CV risk, randomized to ASA v placebo:

✅ No difference in MI’s or deaths, but:
✅ DOUBLE the RISK of gastrointestinal bleeding in ASA group: bit.ly/32ckA6X 😯

#MedEd #drugsafety

5/7 Ex. 4: What about effect of ASA in pts with #diabetes? 🤔

ASCEND trial of 15k pts with diabetes found 1.1% ↘️ in serious vascular events…
…BUT 0.9% absolute ↗️ in bleeding: bit.ly/3mUxVuc

#MedEd #drugsafety

6/7 Ex. 5: ASPREE trial of 19,000 pts >70yrs, without CVD found:

👉ASA showed NO difference in terms of dementia and persistent disability, BUT
👉1.6 excess deaths per 1,000 person years compared to placebo: bit.ly/3djWvkI 😯

#MedEd #ptsafety

7/7 Conclusion:

@drjohnm: “shared understanding of medicine”= Evidence Based Medicine + Shared decision making + Patient-centred medicine 🩺 🤝 🧑🏾

👉Watch full presentation hosted by @drug_evidence Oct 17, 2020: bit.ly/32fsPiA 💻

#MedEd #drugsafety #ptsafety