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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2001;161:2173.
Comparison of the Oral Direct Thrombin Inhibitor Ximelagatran With
Enoxaparin and Prophylaxis Against Venous Thromboembolism After Total Knee
Replacement: A Phase 2 Dose-Finding Study
In a dose-finding study, the authors tested the administration of 4
fixed doses of oral ximelagtran twice daily starting after elective total
knee replacement as prophylaxis against venous thromboembolism and compared
the most effective ximelagatran dose with 30 mg of enoxaparin sodium subcutaneously
twice daily starting 12 to 24 hours after surgery. The 6- to 12-day rates
of overall venous thromboembolism (and proximal deep vein thrombosis or pulmonary
embolism) for the 8-, 12-, 18-, and 24-mg doses of ximelagatran twice daily
were 27% (6.6%), 19.8% (2.0%), 28.7% (5.8%), and 15.8% (3.2%), respectively.
The rates of overall venous thromboembolism (22.7%) and proximal deep vein
thrombosis or pulmonary embolism (3.1%) for enoxaparin did not differ significantly
compared with the 24-mg dose of ximelagatran twice daily (overall difference, -6.9%;
95% confidence interval, -18.0% to 4.2%;
P = .3).
There was no major bleeding with 24 mg of ximelagatran twice daily. Fixed
dose, unmonitored ximelagatran, 24 mg twice daily, starting after surgery
seems to be safe and effective oral prophylaxis against venous thromboembolism
after total knee replacement.
(SEE ARTICLE)
An Evaluation of Choose to Move 1999: An American Heart Association
Physical Activity Program for Women
Choose to Move is a 12-week self-help lifestyle intervention program
designed by the American Heart Association for women across the United States.
The purpose of this study was to evaluate the impact of the 1999 Choose to
Move Program on women's physical activity, diet, and knowledge about heart
disease and stroke. Of the 23 171 participants, 90% were white and 56%
were aged 35 to 54 years. Women who completed the biweekly evaluations (n = 6389 at 2 weeks to 3775 at 12 weeks) reported significantly increased levels
of physical activity, reduced consumption of high-fat foods, and increased
knowledge of symptoms of heart attack or stroke. This program provides an
important model for public health, voluntary, and other health organizations
of population-based, low-cost self-help programs that support the Healthy People 2010 objectives for physical activity, nutrition, and
cardiovascular health.
(SEE ARTICLE)
Gallstone Disease and Related Risk Factors in Patients With Crohn Disease:
Analysis of 330 Consecutive Cases
The prevalence of gallstone disease was significantly higher in 330
consecutive patients with Crohn disease than it was in the general population
(24.0% vs 13.8%). Age, site of disease at diagnosis, and the presence, number,
and site of bowel resections were independently associated with gallstone
disease at multivariate analysis.
(SEE ARTICLE)
Costs of Hepatitis C
Hepatitis C has been called the "epidemic of the new millennium." Annual
deaths from hepatitis C within the United States may surpass those from acquired
immunodeficiency syndrome (AIDS) by 2010. Little is known about the annual
costs of hepatitis C. In this study, standard techniques are used that split
the costs into categories such as medical spending and lost wages. Total costs
were estimated to be $5.5 billion in 1997, which significantly exceeds the
only other hepatitis C estimate ($0.6 billion) for the 1990s; however, it
is less than the annual costs of AIDS ($30 billion in 1992). Hepatitis C costs
will rise considerably in the future as more people manifest symptoms and
die.
(SEE ARTICLE)
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