Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part B Therapy
Chapter 6. Therapy (Randomized Trials)
Gordon Guyatt, Sharon Straus, Maureen O. Meade, Regina Kunz, Deborah J. Cook, PJ Devereaux, John Ioannidis
Clinical Scenario
Topics Discussed:
angina, stable, aspirin, clopidogrel, peptic ulcer, randomized controlled trials, trial of therapy, upper gastrointestinal bleeding
Excerpt:
"You are a general internist following a 62-year-old man with
peptic ulcer disease and stable angina for whom you have been prescribing low-dose
aspirin, a statin, an angiotensin-converting enzyme inhibitor, and
as-needed nitrates. Recently, the patient developed an upper gastrointestinal
bleed. Biopsy done at endoscopy was negative for Helicobacter
pylori. In hospital, the gastroenterologist looking after your
patient changed the aspirin to clopidogrel (and supported his action
by citing a systematic review of thienopyridine derivatives, including
clopidogrel, in high-risk vascular patients that found a decrease
in the odds of a gastrointestinal bleed compared with aspirin; odds
ratio, 0.71; 95% confidence interval [CI],
0.59-0.86).1..."
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