Ximelagatran, an oral direct thrombin inhibitor, acts rapidly and predictably
and could simplify anticoagulant therapy. Two articles in this issue of JAMA report results from clinical trials assessing the
efficacy and safety of ximelagatran compared with standard care in the treatment
of deep venous thrombosis (DVT) or in the prevention of stroke in patients
with atrial fibrillation. In the DVT treatment trialArticle, patients were randomly assigned to receive fixed-dose ximelagatran, 36 mg
twice daily, or to receive standard therapy with low-molecular-weight heparin
and adjusted-dose warfarin. In the stroke prevention studyArticle, patients were randomly assigned to fixed-dose ximelagatran or adjusted-dose
warfarin. In both studies, ximelagatran was as effective as standard therapy
and was associated with comparable low rates of bleeding events but was also
associated with increased levels of liver enzymes. In a third article, O’Brien
and GageArticle describe their analysis of quality-adjusted
survival and cost, comparing treatment with ximelagatran, warfarin, or aspirin
for stroke prevention in 70-year-old patients with chronic atrial fibrillation.
The authors found that ximelagatran is cost-effective only for patients with
a high risk of intracranial hemorrhage or a low quality of life while taking
warfarin. In an editorial, GurewichArticle reviews the safety
and efficacy data from these and other trials of ximelagatran.
When guns are present in the home, storing them locked and unloaded,
with ammunition stored separately and locked, is recommended to reduce youth
access to guns. However, whether these measures prevent firearm suicide or
unintentional injury in children and adolescents is not clear. Grossman and
colleaguesArticle conducted a case-control study of firearm-related
unintentional and self-inflicted injuries in youth and measured their association
with home firearm storage practices. They found that storing guns locked or
unloaded and storing ammunition locked and separately were associated with
reductions in risk of suicide and unintentional firearm injury. In an editorial,
Cole and JohnsonArticle discuss the importance of persuading
families who keep firearms in the home to implement safe storage practices.
Patients with cancer are at increased risk of venous thrombosis, but
few studies have addressed factors that identify patients at highest risk.
Blom and colleagues assessed risk factors for first deep venous thrombosis
or pulmonary embolus in patients 18 to 70 years of age. They found that having
a malignancy increased the risk of thrombosis 7-fold. Patients with cancer
who were at the highest risk of venous thrombosis had a hematologic malignancy,
were diagnosed within the past few months, had distant metastases, and were
carriers of factor V Leiden or prothrombin 20210A mutations.
Perinatal arterial ischemic stroke (PAS) is an important cause of neurologic
disabilities in infants, but factors associated with increased risk of PAS
are not clear. Lee and colleagues conducted a case-control study to identify
maternal and infant characteristics associated with risk of PAS. Among a number
of maternal and fetal factors more common in cases than controls, history
of infertility, preeclampsia, prolonged rupture of membranes, and chorioamnionitis
were independently associated with PAS in multivariate analyses.
Mental health experts say that psychosocial health services are urgently
needed to help tsunami survivors in South Asia cope with psychological trauma
that could have an impact for years to come.
Pathogenesis and treatment of vitiligo.
Authors are invited to submit manuscripts for the annual JAMA issue on medical education.
For your patients: Information about vitiligo.
Theme issues on medical applications of biotechnology coming next week
in JAMA and in some of the February Archives Journals.
This Week in JAMA . JAMA. 2005;293(6):651. doi:10.1001/jama.293.6.651