MinervaBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7058.698 (Published 14 September 1996) Cite this as: BMJ 1996;313:698
A case-control study of stroke in patients with non-rheumatic atrial fibrillation (New England Journal of Medicine 1996;335:540-6) showed that prophylaxis with oral anticoagulants will be most effective as well as safe when the international normalised ratio is between 2.0 and 3.0. Unfortunately, the risk of either ischaemic stroke or intracranial haemorrhage rises steeply beyond those boundaries, so close monitoring is needed.
The history of the treatment of multiple sclerosis is one of false dawns (such as hyperbaric oxygen and gluten free diets), and it seems that interferon beta 1b may now be added to the list: a review in the “Journal of Neurology, Neurosurgery, and Psychiatry” (1996;61:239-41) describes the five year results of the major trial as disappointing. Nevertheless, says the editorial, these are exciting times, with many other drugs being assessed, and large trials are the way to turn hope into reality.
Membranous nephropathy is said to be the most common diagnosis in adults with the nephrotic syndrome. A cause is found in only one fifth of cases, but in a series of 125 patients seen at the Mayo Clinic (JAMA 1996;276:466-9) 29 had been taking non-steroidal anti-inflammatory drugs and in 13 this was thought to be the cause of the nephropathy. In such cases withdrawal of the …