BMJ Update

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Am J Cardiol 2005 May 15;95(10):1218-22.
Analysis of risk of bleeding complications after different doses of aspirin in 192,036 patients enrolled in 31 randomized controlled trials.
Serebruany VL , et al.

Resultados del trabajo: Despite substantial differences in the reporting patterns of bleeding complications, low-dose ASA was associated with the lowest risk, and moderate doses caused a relatively high hemorrhagic event rate, especially with regard to minor, gastrointestinal, and total bleeding, and stroke. These findings should be considered when using combination antiplatelets, anticoagulant therapy, or both, with ASA, especially with the daily dose of >100 mg.
Comentarios de los expertos: Comentario 1: Útil, pero pienso que ya se conoce bien.
Comentario 2: Revisión y metanálisis algo confusa dado que los riesgos no son claros y hay problemas con el método. Mas allá de eso, creo que a los clínicos les preocupa saber lo que sucede con dosis de aspirina de 100mg o menos. Comentario 3:  La historia gastrointestinal y el tiempo del sangrado serían datos interesantes y útiles a incluir.
Comentario 4: Es bueno recordar hechos/sospechas que uno ya ha oído.

(Código 20)

Health Technol Assess 2005 Apr;9(14):1-203, iii-iv.
Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation.
McCormack K, et al.

Resultados del trabajo: For the management of unilateral hernias, the base-case analysis and most of the sensitivity analysis suggest that open flat mesh is the least costly option but provides less quality adjusted life years (QALYs) than TEP or TAPP. TEP is likely to dominate TAPP (on average TEP is estimated to be less costly and more effective). It is likely that, for management of symptomatic bilateral hernias, laparoscopic repair would be more cost-effective as differences in operation time (a key cost driver) may be reduced and differences in convalescence time are more marked (hence QALYs will increase) for laparoscopic compared with open mesh repair. When possible repair of contralateral occult hernias is taken into account, TEP repair is most likely to be considered cost-effective at threshold values for the cost per additional QALY above 20,000 pounds. The increased adoption of laparoscopic techniques may allow patients to return to usual activities faster. This may, for some people, reduce any loss of income. For the NHS, increased use of laparoscopic repair would lead to an increased requirement for training and the risk of
serious complications may be higher.
Comentarios de los expertos: Es poca la información clínicamente relevante que se obtiene.

(Código 37)

Br J Surg 2005 May;92(5):557-62.
Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty for obesity.
Olbers T, et al.

Resultados del trabajo: LRYGBP and LVBG were comparable in terms of operative safety and postoperative recovery, but weight reduction was better after LRYGBP.

(Código 49)

Br J Surg 2005 May;92(5):539-46.
Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy.
Knaebel HP, et al.

Resultados del trabajo: The quality and quantity of information extracted from the available trials are insufficient to enable any firm conclusion to be drawn on the optimal surgical technique of pancreatic stump closure; there is a trend in favour of the stapling technique.
Comentarios de los expertos: Comentario 1: El artículo no ayuda a resolver el tema del cierre manual versus el engrampado del contenido intra abdominal. En este caso, el remanente de la resección pancreática. Sin embargo, el estudio ofrece un útil resumen de los datos disponibles, una referencia a tener a mano y una discusión razonable de un tema con una respuesta difícil de alcanzar. Comentario 2: Poca información nueva al tratarse de una revisión. Hemos engramapado y suturado el extremo del páncreas durante 25 años con buenos resultados en ambos casos. Comentario 3: Los metanálisis deberían realizarse cuando hay un número suficiente de investigaciones clínicas aleatorizadas.

(Código 60)

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