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Preventive Cardiology
Iron deficiency and anemia due to daily low-dose aspirin (July 2023)
Aspirin can increase bleeding risk, but data are lacking on anemia and iron deficiency in individuals without clinically obvious bleeding. A new analysis of a randomized trial in older adults assigned to daily low-dose aspirin or placebo has documented a small but statistically significant increase in the rate of anemia (51 per 1000 person-years in the aspirin group versus 43 per 1000 person-years with placebo) and iron deficiency (13 percent with aspirin versus 10 percent with placebo).2 While the decision to perform surveillance for anemia or iron deficiency in individuals taking aspirin is individualized, these data provide a rationale for surveillance in those who choose it.
Nephrology and Hypertension
Kidney effects of different glucose-lowering agents in patients with type 2 diabetes (July 2023)
In prior studies, glucagon-like peptide 1 (GLP-1) receptor agonists reduced albuminuria and slowed estimated glomerular filtration rate (eGFR) decline among patients with diabetic kidney disease, and these agents are therefore used in such patients if additional glucose control is needed. By contrast, in a large trial in over 5000 individuals with type 2 diabetes on metformin monotherapy that directly compared the kidney effects of the GLP-1 receptor agonist liraglutide with a dipeptidyl peptidase 4 inhibitor, insulin, and glimepiride, there were no significant differences among the groups at five years in terms of eGFR decline or development of chronic kidney disease.3 However, the patients enrolled had normal kidney function and well-controlled blood pressure at baseline, and the number of events was small. Thus, GLP-1 receptor agonists are still appropriate in patients with diabetic kidney disease whose glycated hemoglobin is far from their goal despite therapy with metformin.
Primary Care
Limited role for suicide risk screening (July 2023)
Suicide is the tenth leading cause of death in the United States. Nevertheless, UpToDate recommends not routinely screening for suicide risk in adult primary care patients, given lack of evidence that screening reduces suicidal behavior. A systematic review for the United States Preventive Services Task Force found insufficient evidence to determine whether the benefits of screening outweigh the harms in the general population of United States adults (including pregnant and postpartum persons and adults 65 years or older).4,5 However, this conclusion did not apply to individuals with existing psychiatric disorders or past histories of suicide attempts; in such patients, standard evaluation includes asking about suicidal ideation and behavior.
General Adult Emergency Medicine
No benefit of opioids for acute low back pain (August 2023)
Opioid analgesics are often used to treat acute low back pain despite limited supporting evidence. In a randomized trial of 347 adults presenting to the emergency department or primary care clinic with acute, nonspecific low back pain, oxycodone (up to 20 mg daily for six weeks) was no more effective for pain relief or functional improvement than placebo.1 There was a higher risk of potential opioid misuse in patients in the oxycodone group at one-year follow-up (20 versus 10 percent). These results support UpToDate's recommendation against routine opioid use for acute low back pain, given the lack of benefit and potential for misuse.
1. Jones CMP, Day RO, Koes BW, et al Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Lancet. 2023;402(10398):304. [Context Link]
2. McQuilten ZK, Thao LTP, Pasricha SR, et al Effect of Low-Dose Aspirin Versus Placebo on Incidence of Anemia in the Elderly: A Secondary Analysis of the Aspirin in Reducing Events in the Elderly Trial. Ann Intern Med. 2023;176(7):913. Epub 2023 Jun 20. [Context Link]
3. Wexler DJ, de Boer IH, Ghosh A, et al Comparative Effects of Glucose-Lowering Medications on Kidney Outcomes in Type 2 Diabetes: The GRADE Randomized Clinical Trial. JAMA Intern Med. 2023;183(7):705. [Context Link]
4. O'Connor EA, Perdue LA, Coppola EL, Henninger ML, Thomas RG, Gaynes BN. Depression and Suicide Risk Screening: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2023;329(23):2068. [Context Link]
5. Barry MJ, Nicholson WKUS Preventive Services Task Force. Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(23):2057. [Context Link]
Disclaimer: This content is provided for reference purposes only and represents a portion of the UpToDate topic. Readers should not rely on the content or any information cited here as being applicable to specific patient circumstances. All topics are updated as new evidence becomes available and our peer review process is complete.