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BMJ 2012; 344 doi: (Published 16 May 2012) Cite this as: BMJ 2012;344:e3359

Atrial fibrillation carries a higher risk of stroke for women

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Women with atrial fibrillation have a higher risk of ischaemic stroke than men with atrial fibrillation. We still don’t know why, but a recent cohort study tells us it has little to do with women being undertreated. In an analysis of claims data from Canada, women filled more prescriptions for warfarin than men in the first month after a hospital admission for atrial fibrillation. And adherence was good in both sexes.

Further analyses linking three administrative databases suggest the sex differential is not due to the different ages or clinical profiles of men and women admitted for atrial fibrillation. After full adjustment for comorbidities, warfarin treatment, and the individual components of the CHADS2 score (congestive heart failure, hypertension, age over 75 years, diabetes mellitus, and previous stroke or transient ischaemic attack), women were still 14% more likely to have an ischaemic stroke than men (2570/44 115 v 1696/39 398; hazard ratio 1.14, 95% CI 1.07 to 1.22).

The gap between men and women was widest in those aged 75 or over. Women in this age group deserve more attention from stroke prevention researchers, say the authors, particularly those designing trials of newer anticoagulants. We should also develop and test risk scores for stroke that include sex as an independent risk factor.

Probiotics protect against diarrhoea associated with antibiotics

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More evidence that probiotics can help prevent diarrhoea associated with antibiotics has emerged from a meta-analysis of randomised trials. The authors found 82 trials after a systematic search but only 63 reported how many people took the probiotics, how many took the control treatment, and how many developed diarrhoea. Across these 63 trials, probiotics were associated with a 42% reduction in the risk of diarrhoea (relative risk 0.58, 95% CI 0.50 to 0.68; number …

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