Internal Medicine World Report, August 2007, Volume 0, Issue 0

Complementary Therapies Lower Chance of Pregnancy in Infertile Women

LYON, France—Women with infertility problems should avoid using complementary therapies intended to boost their chances of getting pregnant, investigators said at the European Society of Human Reproduction and Embryology annual meeting.

The warning is based on new data showing that therapies such as acupuncture, reflexology, or dietary supplements markedly reduce the likelihood that invitro fertilization (IVF) will be successful.

Jacky Boivin, PhD, at Cardiff University, Wales, and colleagues looked at the psychosocial and medical profiles of 818 women who underwent IVF treatment. Those who also used complementary therapy had a 20% lower pregnancy rate than those who used IVF alone, although a direct causal link could not be established.

Complementary therapies may lessen the odds of pregnancy by interfering with established IVF treatments, Dr Bovin said, suggesting that the use of complementary medicines may serve as a marker for patients who require more attention.

Extended Enoxaparin Prophylaxis Benefits Patients with Reduced Mobility

GENEVA, Switzerland—A 5-week course of prophylactic enoxaparin (Lovenox) nearly halves the risk of venous thromboembolism (VTE) in acutely ill medical (as opposed to surgical) patients with recent limited mobility when compared with the usual 10-day regimen, based on data presented at the Congress of the International Society on Thrombosis and Hemostasis.

Victor Tapson, MD, professor of medicine at Duke University Medical Center, Durham, NC, reported preliminary results from the Extended Clinical Prophylaxis in Acutely Ill Medical Patients study, which was conducted in 20 countries. Some 5105 patients received enoxaparin 40 mg subcutaneously once daily for 10 days and were then randomized to receive the same enoxaparin regimen or placebo for an additional 28 days.

A 10-day course of thromboprophylaxis with enoxaparin is the standard regimen in acutely ill patients, Dr Tapson noted. However, clinical practice suggests that the risk of VTE may continue beyond 10 days, especially in patients with reduced mobility. The safety and efficacy of extended prophylaxis has been demonstrated in several high-risk surgical groups, but it had never before been examined in acutely ill medical patients, a population known to be at high risk for VTE.

Participants were aged >75 years or had a history of VTE or a diagnosis of cancer and predefined acute medical illness. The primary end point was the incidence of asymptomatic or symptomatic deep-vein thrombosis, or symptomatic or fatal pulmonary embolism during the double-blind period. A significant 44% relative risk reduction in VTE events was reported for extended-duration prophylaxis with enoxaparin versus placebo.

More Evidence that Long-Haul Flights Increase Risk of Clotting

GENEVA, Switzerland—Flights that last ≥4 hours nearly double the risk of venous thromboembolism (VTE), according to a preliminary report issued by the World Health Organization (WHO). But data also show that the risk remains relatively low, at roughly 1 in every 6000 long-haul passengers.

The findings—which also apply to travelers who remain immobile on a train, bus, or car—are from the ongoing WHO Research Into Global Hazards of Travel project. Besides immobility, the report identified several other factors that can increase the risk of VTE—being obese or very tall or very short, using oral contraceptives, and having an inherited blood disorder that increases the tendency to clot.

Pegaptanib Beneficial in Patients with Diabetic Retinopathy

VIENNA, Austria—Patients with diabetic retinopathy who are treated with pegaptanib sodium (Macugen) injections continue to have improved visual acuity after their treatment has been halted, according to data described at the European Society of Ophthalmology annual meeting.

Nearly one half of all diabetic patients have some degree of diabetic retinopathy, the leading cause of adult blindness in developed countries. Erdem Ergun, MD, reported a visual acuity gain of ≥10 letters at 36 weeks in 34% of those who received pegaptanib injections compared with only 10% of those in a sham group. These gains were maintained for 46 weeks after the injections were stopped.

Dr Ergun, of the Department of Ophthalmology, Sanatorium Hera, Vienna, Austria, said that diabetic retinopathy is presently treated using laser surgery, which usually stabilizes, but does not improve, visual function. Intravitreal triamcinolone (Kenalog) is also used, but it is only "temporarily effective," and it has been associated with cataract formation and significant increases in intraocular pressure.

Compiled by our Paris-based correspondent Jill Stein.