BMJ 2011; 342: 833 – 882 (16th April)

This issue’s main contribution to me was to disentangle a couple of points I’d struggled with from guidelines.   Firstly, NICE guidance on antiplatelet therapy post-CVA – I had a hell of a time recently trying to figure out whether I should co-prescribe aspirin with clopidogrel, as the guidance didn’t seem to say specifically.  In the end I opted not to, which was, I was relieved to see, the right decision; aspirin plus clopidogrel gives a bleeding risk as high as warfarin, and the increased risk balances out the decreased risk of future vascular events.  For the same reason, warfarin is not indicated as antiplatelet therapy in post-CVA patients in sinus rhythm.

The other point was target systolic BPs, which I can never remember for the life of me, given how many slight variations in targets there seem to be according to indication and guideline.  This article, based on the ABCD guidelines, fortunately kept it simple – 140 for uncomplicated cases, 130 for those at increased risk for other reasons (diabetes, cardiovascular disease, or impaired renal function).  This comes, apparently, from SIGN, so now I’ll probably find out that here on this side of the border we’re meant to be working with some other figure.  Frankly, those sound as good to me as any.


About Dr Sarah

I'm a GP with a husband and two young children.
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