geoffrey modest medical blogs

  A recent long-term Swedish study found that increased resting heart rate was associated with cognitive decline and dementia in older adults (see  dementia inc heart rate AlzDem2021  in dropbox, or DOI: 10.1002/alz.12495)     Details:    -- 2147 people at least 60yo in the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) who were initially free from dementia and regularly followed from baseline at 2001-4 until 2013-16, with follow-up exams conducted every 6    years for the younger cohort (age 60, 66, and 72) and every three years for the older cohort (age 78, 81, 84, 87, 90, 93, 96, and 99 years)  -- mean age 71, 62% female, 12% elementary school education/48% high school/80% university  -- 44% never smoker/40% former smoker/16% current smoker;   light physical activity (walking, biking, light aerobics) every day 38%, several times per week 40%, a few times per month 12%, less frequent 6%, none 5%)  -- use of beta blockers 19%, use of calcium blockers 2%, digoxin 1% 

  Though the general approach to people with unprovoked venous thromboembolism has been for extended anticoagulation, a recent systematic review and meta-analysis suggested that long-term anticoagulation may make the risk of major bleeding outweigh the benefit (see   dvt bleeding risk anticoag after unprov VTE AIM2021  in dropbox, or doi:10.7326/M21-1094)    Details:  -- 14 RCTs and 13 prospective cohort studies of patients with unprovoked venous thromboembolism (VTE) were evaluated for major bleeding  with extended  anticoagulation. Overall, low risk of bias in these chosen studies  -- 70,202 patients: 9982 patients were receiving a vitamin K antagonist (VKA, such as warfarin/coumadin and its derivatives) and 7220 received a direct oral anticoagulant (DOAC, though most of the studies used rivaroxaban)      -- all patients had had an unprovoked or minimally provoked VTE (the latter in those with mild transient VTE risk factors), were on a VKA with an INR goal of 2-3 for a minimum of si