Medical Bulletin 19/ November/ 2024 - Video

People who take an anticoagulant medicine double their risk of an internal bleed if they take a type of painkiller called a non-steroidal anti-inflammatory drug such as ibuprofen, diclofenac or naproxen, according to research published in the European Heart Journal.

The new study is the largest of its kind and shows that there is an increase in the risk of bleeding in the gut, brain, lungs and bladder. The research was carried out by a team from Aarhus University Hospital in Denmark. They used data from Danish nationwide registries on 51,794 people given anticoagulants to treat a blood clot between 2012 and 2022.

The researchers found that the risk of a bleed was 2.09 times higher when people were taking an NSAID and a blood thinner, compared to those taking a blood thinner and no NSAID. The risk for ibuprofen was 1.79 times higher, for diclofenac the risk was 3.3 times higher and for naproxen, the risk was 4.1 times higher.

The risk of a bleed in the gut with NSAID use was 2.24 times higher. The risk of a bleed in the brain was 3.22 times higher. In the lungs, the risk of a bleed was increased by 1.36 times. In the urinary tract the risk of a bleed was 1.57 times higher. There was also almost a tripling of the risk of anaemia caused by bleeding.

The researchers looked at several types of blood thinners – including rivaroxaban, apixaban, dabigatran, edoxaban and warfarin – and found a similar pattern of risk.

The study’s author, Mr Søren Riis Petersen, from Aarhus University Hospital, said: “We found that for patients taking blood thinners for blood clots in the legs or lungs, using NSAIDs doubled the risk of bleeding compared with not using NSAIDs. The increased bleeding risk associated with NSAID use was not limited to the digestive tract but also seemed to affect other organ systems. “For people taking blood thinners for blood clots in their legs or lungs, our research highlights the importance of being cautious when considering NSAIDs for pain or inflammation. We recommend that patients consult their doctor before taking NSAIDs along with a blood thinner.”

Reference: Søren Riis Petersen, Kasper Bonnesen, Erik Lerkevang Grove, Lars Pedersen, Morten Schmidt, Bleeding risk using non-steroidal anti-inflammatory drugs with anticoagulants after venous thromboembolism: a nationwide Danish study, European Heart Journal, 2024;, ehae736, https://doi.org/10.1093/eurheartj/ehae736

Beer drinkers have lower-quality diets, are less active, and are more likely to smoke cigarettes than people who drink wine, liquor, or a combination, according to a study presented at The Liver Meeting, held by the American Association for the Study of Liver Diseases.

Using a survey of a nationally representative sample of more than 1,900 U.S. adults who reported current alcohol use, researchers compared the diet quality among people who consume beer only (38.9%), wine only (21.8%), liquor only (18.2%), or a combination of alcohol types (21%), measuring self-reported eating habits against the Healthy Eating Index, a validated standardized tool based on dietary guidelines.

None of the alcohol-using groups came close to achieving the 80-point score that is considered an adequate diet on the 100-point Healthy Eating Index, researchers said, but the beer drinkers scored lowest at 49. Wine drinkers scored 55, and both liquor-only drinkers and combination drinkers scored nearly 53.

Beer-only drinkers, who were more likely to be male, younger, smokers, and low income, also reported the highest total daily caloric intake, adjusting for body weight, and the lowest level of physical activity.

Researcher said the differences in diet quality among drinkers could be attributed to the context in which food and alcohol consumed together. Another possibility is the inverse, where dietary choices influence the choice of alcohol consumed.

For prevention of liver disease and other health issues, physicians should ask about the type of alcohol consumed to guide discussion of healthy behaviors, said Madeline Novack, chief resident at Tulane School of Medicine’s internal medicine residency program and lead author of the study. For example, findings of this study can be applied to patients who identify as beer-only drinkers and physicians could suggest increasing fruit and vegetable intake, as well as physical activity.

Reference: https://www.aasld.org/beer-only-drinkers-diets-are-worse-wine-drinkers#:~:text=None%20of%20the%20alcohol%2Dusing,combination%20drinkers%20scored%20nearly%2053.

Type 2 diabetes can lead to diabetic kidney disease, but a class of drugs that cause the kidneys to remove glucose through urine has been gaining attention. An Osaka Metropolitan University-led research group has investigated how such drugs maintain kidney health. The findings were published in Frontiers in Endocrinology.

Known as SGLT2 i.e. sodium-glucose cotransporter-2 inhibitors, the drugs are used to treat type 2 diabetes along with an exercise and diet regimen. The group led by Graduate School of Medicine Associate Professor Katsuhito Mori focused on the sodium-glucose cotransporter-2 inhibitor canagliflozin and its effects on the kidney.

Using BOLD (blood oxygenation level-dependent) MRI, a method used to see changes in blood oxygen flow in the brain to monitor activity, the group found that patients on canagliflozin for five days showed more oxygen in their kidneys the first day after administration of the drug. The researchers believe this indicates that sodium-glucose cotransporter-2 inhibitors might improve the oxygenation of the kidneys, thereby protecting the organs.

“In animal experiments, the amount of oxygen in the kidneys can be measured by inserting a microelectrode, but this is not possible in humans,” Professor Mori explained. “BOLD MRI can measure kidney oxygenation non-invasively, and this is expected to become an important technology for elucidating the mechanisms of kidney disease for the development of therapeutic drugs.”

Reference: Mori K, Inoue T, Machiba Y, Uedono H, Nakatani S, Ishikawa M, Taniuchi S, Katayama Y, Yamamoto A, Kobayashi N, Kozawa E, Shimono T, Miki Y, Okada H and Emoto M (2024) Effects of canagliflozin on kidney oxygenation evaluated using blood oxygenation level-dependent MRI in patients with type 2 diabetes. Front. Endocrinol. 15:1451671. doi: 10.3389/fendo.2024.1451671

A new study finds that prenatal exposure to tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis causes a rewiring of the fetal brain which could increase the risk of addiction to opioids later in life.

The preclinical animal study, led by researchers at the University of Maryland School of Medicine, was published in the journal Science Advances. Tetrahydrocannabinol caused certain brain cells, called dopamine neurons, to respond in a hyperactive way, causing a heightened increase in dopamine release. This was accompanied by heightened neuronal responsiveness to cues associated with rewards like a light turning on to indicate that food or an opioid drug was available.

The American College of Obstetricians and Gynecologists recommends that doctors counsel patients on concerns about potential adverse health consequences of continued use of cannabis during pregnancy.

This illustration shows that male animals exposed to tetrahydrocannabinol in the womb experience a greater surge in the "reward-seeking" brain chemical dopamine when exposed to opioid drugs as adolescents compared to those that were never exposed to tetrahydrocannabinol.

Researchers found that fetuses exposed to a moderately low dose of tetrahydrocannabinol developed changes in how their reward system functioned, causing them to develop an at-risk phenotype for opioid seeking. Animals previously exposed to tetrahydrocannabinol in utero display a dramatically increased motivation to press a lever that would deliver a dose of opioid drugs compared to those that were not previously exposed to tetrahydrocannabinol. When tetrahydrocannabinol -exposed animals reached early adulthood, they were more likely to show enhanced opioid-seeking and were more likely to relapse upon opioid-associated environmental cues compared to those animals who were not exposed to tetrahydrocannabinol in the womb. They were also more likely to develop persistent addiction-like behaviors.

Reference: https://www.medschool.umaryland.edu/news/2024/exposure-to-marijuana-in-the-womb-may-increase-risk-of-addiction-to-opioids-later-in-life-study-finds.html