A solution to the warfarin dilemma
he onward march of medical progress may have slowed in recent years, but behind the scenes, as it were, the cumulative effect of modest incremental advances can be very impressive. The common disturbance of heart rhythm, atrial fibrillation, is a case in point, and particularly the prevention of its main complication, a tendency for a blood clot to form within the atrium, scattering minuscule fragments or emboli up into the brain to cause a stroke. The benefits of the blood-thinning drug warfarin in reducing such a misfortune are similar to those of treating markedly raised blood pressure, reducing the risk by almost two thirds – 45 fewer strokes for every 1,000 patients treated. That is a big deal.
The problem, as many will know, is that for humans, warfarin has the same drawback that, for a while, made it such a successful rat poison. The substantial benefit of preventing all those strokes is almost offset, especially for oldies, by its tendency to cause a potentially catastrophic haemorrhage from the gut or into the brain. Hence the requirement for those regular (and onerous) blood tests to calibrate its dose.
Then, just over 10 years ago, the discovery of a new class of blood-thinning drugs resolved the doctors’ dilemma of whether or not to prescribe warfarin. These novel oral anticoagulants (or NOACS, as they are known) obviate the need for those blood tests while reducing by half the risk of those bleeding complications. There are several to choose from, but the most recent review, published a couple of months ago, found Apixaban to be the safest and most effective.
Skating on thin ice
The grace and power of Germany’s Aliona Savchenko and Bruno Massot during the Winter Olympics has been acclaimed as “the greatest figure-skating performance the world has ever seen”. The technicalities of those triple axels and quadruple spins may be obscure but their precise combination of vertical velocity and angular momentum is awesome, spinning at rates of 440 revolutions per minute and landing with an impact up to eight times their body weight.
For the amateur, though, skating is inevitably hazardous. In 1871, the British Medical Journal reported that the toll of accidents among the estimated 50,000 skaters on the frozen Serpentine in London’s Hyde Park included 66 immersions, 271 contused wounds, 10 fractures, and “several cases of severe concussion”. For all that, the medical authorities commended it as “a generally useful pastime”: “the measured, rhythmical movements, poise and balance […] combine all the benefits of gentle exercise with minimal exertion”.
Hot under the covers
This week’s medical query comes courtesy of Mrs SS from Leeds, now well past the change of life and the associated hot flushes. But now she finds that within half an hour of retiring to bed, she becomes uncomfortably hot, even with the bedroom temperature at just 11 degrees during the winter months. Two persons’ body heat under the same quilt make her so desperate, her husband must leave the marital bed to sleep in the spare bedroom, “which is not good for our relationship”.
The two further unusual features are that her sleep is shallow and dream-filled, with a sense of panic on waking; and she has also noted that her normally smooth skin becomes dry and rough when overheated. Might anyone, she wonders, be similarly afflicted, or have found a preventive remedy?
From head to toe…
Finally, my thanks to a Lincolnshire farmer whose lifetime battle against dandruff ended several years ago with the discovery of Head and Shoulders shampoo. Subsequently, it occurred to him in the shower one day that the same might also conquer his long-standing flaky and itchy athlete’s feet. So, for a couple of weeks, he immersed them during his regular threeminute shampooing ritual and, sure enough, they healed beautifully – as did his painful cracked heels. A felicitous outcome indeed.
It cuts the risk by almost two thirds – 45 fewer strokes for every 1,000 patients. That is a big deal