CMAJ • August 26, 2008; 179 (5).
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Highlights

Stopping anticoagulants after unprovoked thromboembolism

Women with 0 or 1 risk factor may safely discontinue oral anticoagulant therapy after 6 months of treatment following a first unprovoked venous thromboembolism. This is the conclusion reached by Rodger and colleagues, whose multicentre prospective cohort study included 646 participants. The risk factors were hyperpigmentation, edema or redness of either leg, D-dimer ≥ 250 µg/L, a body mass index ≥ 30 kg/m2 and age ≥ 65 years. See Research, page 417


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  		Photo by: Visuals Unlimited/Corbis

 
In an accompanying commentary, Kearon says that the preference of patients, after the risks and benefits of treatment have been explained to them, should also influence the duration of treatment. See Commentary, page 401

Cholesterol, cancer and diabetes

Both low and high levels of low-density lipoprotein (LDL) cholesterol are associated with an increased risk of cancer among patients with type 2 diabetes. Yang and colleagues discovered this V-shaped association in the subgroup of 3800 patients with diabetes who were not taking statins. See Research, page 427


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  		Hazard ratios (and 95% confidence intervals) for low-density lipoprotein cholesterol levels associated with cancer among patients with diabetes who did not use statins.

 
Confounding factors such as indication for use of statins, lifestyle factors and socioeconomic status need to be considered when we look at the association between high levels of LDL cholesterol and the risk of cancer, say Ding and Hu in a related commentary. See Commentary, page 403

Warnings of serious adverse events

Regulatory warnings slowed the growth of the use of atypical antipsychotic drugs among elderly patients with dementia, but they did not reduce the overall prescription rate of these drugs. Valiyeva and colleagues came to this conclusion from their analysis of prescription claims data of atypical and conventional antipsychotic drugs before and after 3 regulatory warnings had been issued. The authors call for more effective interventions to improve postmarket drug safety. See Research, page 438

Some health care warnings fail to achieve the desired effect because they have not provided physicians with information about the effectiveness and safety of alternative treatment options, says Katz in a related commentary. See Commentary, page 405

Colour of eyes

Read about a 35-year-old woman with 2 different eye colours and miosis in her left eye in our Teaching case. See Practice, page 447

Colour of urine

What is the cause of purple-coloured urine in a 58-year-old man with an indwelling catheter? See Clinical images, page 491


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Patient safety

The patient safety movement may provide the rationale and justification for a no-fault compensation system. See News, page 407

Safety of prescription drugs

Health Canada is investing $1 million in an independent research network to study the safety of prescription drugs. Is it enough? See News, page 412


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Stopping anticoagulant therapy after an unprovoked venous thromboembolism
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Can. Med. Assoc. J. 2008 179: 401-402. [Full Text] [PDF]

Cancer and cholesterol: understanding the V-shaped association in patients with diabetes
Eric L. Ding, ScD and Frank B. Hu, MD PhD
Can. Med. Assoc. J. 2008 179: 403-404. [Full Text] [PDF]

Concerns about health care warnings and their impact on prescribing behaviour
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Fault/no fault part 2: uneasy bedfellows
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Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy
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Independent associations between low-density lipoprotein cholesterol and cancer among patients with type 2 diabetes mellitus
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Effect of regulatory warnings on antipsychotic prescription rates among elderly patients with dementia: a population-based time-series analysis
Elmira Valiyeva, PhD, Nathan Herrmann, MD, Paula A. Rochon, MD MPH, Sudeep S. Gill, MD MSc, and Geoffrey M. Anderson, MD PhD
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Heterochromia
Habib Ur Rehman, MBBS
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Purple urine bag syndrome
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Health Canada's investment in new post-market drug surveillance network a "pittance"
Ann Silversides
Can. Med. Assoc. J. 2008 179: 412-413. [Full Text] [PDF]




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