DOACs less likely than warfarin to cause AKI

The risk of acute kidney injury (AKI) in elderly people with atrial fibrillation (AF) is lower with a DOAC (dabigatran, rivaroxaban, or apixaban) compared with warfarin, a Canadian study shows.

A population-based cohort study of 20,683 outpatients with AF aged over 66 found that those who were newly prescribed a DOAC was associated with a significantly lower risk of AKI compared to warfarin (weighted Hazard Ratio 0.65 for dabigatran, 0.85 for rivaroxaban and 0.81 for apixaban).

The lower risk of AKI associated with DOACs was seen consistently across all levels of eGFR, according to findings published in the Clinical Journal of the American Society of Nephrology.

The risk of AKI was also found to be lower among users of all DOACs compared to warfarin users who had a percentage of INR measurements ≤56.1%.

LVH a biomarker for cerebral atrophy

Left ventricular hypertrophy (LVH) is a potential biomarker for cerebral atrophy in patients with type 2 diabetes, Australian research has shown.

Dr Sheila Patel from the vascular neurodegeneration research lab at the Florey Institute told the Australasian Diabetes Congress (ADC) 2021 meeting that a study involving 150 adults with T2D found LVH, determined by transthoracic echocardiography, was present in 27% of participants.

High resolution 3T MRI showed that participants with LVH had significantly more atrophy of cortical thickness and the cerebral cortex compared to those without LVH at baseline.

People with LVH also had more atrophy in subcortical structures such as the putamen and the cerebellar cortex.

Dr Patel said the findings suggested that type 2 diabetes contributed to accelerated structural brain ageing and brain atrophy, which manifests as cerebral atrophy.

“Both LVH and hypertension appear conflated as risk factors for brain atrophy,” she said.

Speaking to the limbic after her presentation, Dr Patel said that LVH had the advantage of being an easy to perform, single measurement.

“What’s nice about LVH is that it represents lifelong exposure to a person’s vascular risk factors,” she said.

A two-year follow-up of participants is underway and should report early next year.

Top 10 Choosing Wisely tips for COVID-19

An international taskforce on Choosing Wisely for COVID-19 has released its top ten recommendation for the general public and for physicians.

The 18-member taskforce from India, Canada, the US and UK, encompassed the disciplines of public health, primary care, infectious diseases, respiratory medicine, critical care and more.

The five recommendations for the general public reinforce prevention messages, when to get tested and when to seek medical help.

The five recommendations for physicians focus on the management of COVID-19. They are:

• Do not use prescribe unproven or ineffective therapies for COVID-19
• Do not use drugs like remdesivir and tocilizumab except in specific circumstance where they may be of use
• Do use steroids prudently only in patients with hypoxia, and monitor blood sugar levels to keep them in normal range
• Do not routinely perform investigations that do not guide treatment, such as CT scans and inflammatory markers
• Do not ignore the management of critical non-COVID-19 disease during the pandemic.

Read more in Nature Medicine