Blood Transfusions Could Save Lives of Older Heart Attack Patients
Elderly heart attack patients who are anemic should be given blood transfusions as soon as possible as part of their therapy, Yale University researchers said, adding that thousands of lives might be saved if such a recommendation were widely followed in the United States.
Physicians have not done this in the past, experts said, because there was little evidence to support its efficacy.
During a heart attack, heart muscle is starved for oxygen, and oxygen-poor blood resulting from anemia simply makes the situation worse, the researchers said.
Dr. Harlan Krumholz and his colleagues at Yale studied the records of 78,974 Medicare patients treated for heart attacks in 1994 and 1995.
They reported in the Oct. 25 New England Journal of Medicine that about three-quarters of the patients who were anemic did not receive transfusions.
Among those who did, however, the results were dramatic. Those who were mildly anemic and received transfusions were one-quarter less likely to die during the month after the heart attack than those who did not get blood. And those who were severely anemic and received transfusions were about two-thirds less likely to die during the same period.
Birth Control Pills May Weaken Sex Drive
Birth control pills might reduce women’s libido by blunting their sense of smell, Italian researchers reported in the Oct. 26 issue of Human Reproduction, a scientific journal. Salvatore Caruso and his colleagues at the University of Catania studied 60 women who were not using birth control pills, measuring their ability to detect six distinctive odors--anise, musk-ketone, clove, pyridine, citral and ammonia--at different times of the month.
The women were most sensitive to the smells during the period around ovulation. But when the same women were then given birth control pills, that increased sensitivity was blocked and their sensitivity to odors was constant throughout the month.
Some research has suggested that, biologically, odors influence reproductive processes in humans.
Diabetics Warned Against Reusing Insulin Syringes
The American Diabetes Assn. has reiterated its recommendation that diabetics not reuse disposable syringes for injecting insulin. In a statement in the November issue of Diabetes Care, a medical journal, the association warned that new, thinner needles are more likely to bend when reused. If that happens, the bent needle can lacerate the skin or even break off in the tissue. Reusing needles may also lead to inconsistent insulin absorption.
The association also warned that people who inject insulin with an insulin pen should not leave the needle on the pen between injections. That can allow air to enter the system, leading to under delivery of insulin.
Estrogen Therapy May Be Risky for Stroke Victims
Estrogen replacement therapy does not help prevent strokes in women who have already had one and may, in fact, slightly increase the risk of a second stroke, according to a new study.
The study follows recent reports that hormone treatment also is not effective in preventing heart disease.
Based on those studies, the American Heart Assn. in July recommended against prescribing the hormone solely to prevent heart disease and strokes. Estrogen therapy is effective, however, at preventing bone loss and easing symptoms of menopause.
Dr. Catherine M. Viscoli and her colleagues at Yale University studied 991 women, with an average age of 71, who had suffered either full strokes or so-called mini-strokes.
The women were randomly assigned to receive either a standard dose of estrogen or a placebo. The team reported in the Oct. 25 New England Journal of Medicine that, after eight years, 99 of the women getting estrogen had suffered further strokes, compared with 93 of those receiving placebo.
EKG May Not Indicate Accurate Status of Patient
Just because a patient’s electrocardiogram appears normal after a heart attack does not mean the patient is out of danger, according to a new study.
Doctors at Wayne State University in Detroit have found that patients with normal EKGs after a heart attack are about three times as likely to die as was previously thought, a finding that suggests the patients should be given much more aggressive treatment.
An abnormal EKG is one of the primary signs of a heart attack. Such patients are normally given intensive treatment, such as angioplasty, bypass surgery and blood-thinning drugs. But some patients have a seemingly normal EKG. Their heart attack is detected by the presence in blood of enzymes released by damaged heart tissue. Because their EKGs are normal, however, physicians have usually given these patients only minimal treatment.
Dr. Robert Welch and his colleagues at Wayne State compared 30,759 heart attack patients with normal EKGs with 222,875 with abnormal EKGs. Those with normal readings were, in fact, 41% less likely to die while hospitalized than those with abnormal readings, the team reported in the Oct. 24 Journal of the American Medical Assn., but researchers had expected the difference to be much greater.
Overall, 1,752 of the patients with normal EKGs died, about three times as many as had been predicted based on earlier, smaller studies.
Remicade Can Worsen Congestive Heart Failure
Physicians should not prescribe the arthritis drug Remicade to patients with congestive heart failure because it can make their condition worse, the drug’s manufacturer said last week. In a six-week clinical trial, seven of 101 heart patients treated with Remicade died, compared with none of 49 patients who received a placebo, said a spokesman for Centocor, of Malvern, Pa. The trial was conducted because animal testing had suggested the drug might help patients with congestive heart failure.
The drug is also used to treat Crohn’s disease.
Reduce Herb Supplements Before Having Surgery
Patients scheduled for surgery should taper off herbal supplements in the two weeks before the operation because of potential ill effects from the herbs, a Chicago researcher says. In remarks at a conference in San Francisco, Dr. Jonathan Moss, of the University of Chicago’s Pritzker School of Medicine, advised patients to inform their doctor about their use of herbal supplements. Kava, for example, can interact with anesthetics and make it harder for patients to wake up, he said. Ginkgo and others can cause excess bleeding, a particular danger during surgery. Other supplements that have potential for causing problems during surgery include valerian, echinacea, ephedra, garlic, ginseng and St. John’s wort.
*
Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
