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Am Fam Physician. 2020;102(6):332

What anticoagulant medications are preferred to treat venous thromboembolism (VTE)?

Direct oral anticoagulants should be used as first-line agents for the treatment of VTE. Low-molecular-weight heparin is recommended as the anticoagulant of choice in patients with cancer and VTE; however, direct oral anticoagulants may be appropriate in select situations.

Is there an indication for dual antiplatelet therapy after stroke or transient ischemic attack?

A 10- to 21-day course of dual antiplatelet therapy reduces stroke recurrence and improves quality of life after mild stroke or high-risk transient ischemic attack. Low-dose aspirin and a 300-mg loading dose of clopidogrel (Plavix) should be started as soon as imaging rules out hemorrhage. After 10 to 21 days of daily low-dose aspirin and clopidogrel, 75 mg, the patient should be switched to a single antiplatelet drug.

What treatments are recommended for military veterans?

Veterans with chronic musculoskeletal pain and multisystem illness should have symptoms evaluated based on clinical judgment and be treated with a collaborative, team-based approach, including a behavioral health specialist. Veterans with suspected posttraumatic stress disorder should undergo diagnostic evaluation that includes determination of Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria and acute risk of harm to self or others. Risk-based management, clinical interventions, comprehensive and regularly updated safety planning, and reliable continuity of care may reduce the risk of suicide.

What treatments has the U.S. Food and Drug Administration approved for pre-exposure HIV prophylaxis?

In addition to once-daily oral treatment with combined tenofovir disoproxil fumarate and emtricitabine (Truvada), the U.S. Food and Drug Administration has approved combined tenofovir alafenamide and emtricitabine (Descovy) for preexposure prophylaxis in selected people at risk of sexually acquiring HIV infection. Combined tenofovir alafenamide and emtricitabine is not approved for preexposure prophylaxis in patients who have receptive vaginal sex because its effectiveness has not been evaluated in this population.

When should women with gestational diabetes mellitus receive postpartum diabetes screening?

Women with gestational diabetes should be screened for diabetes with a 75-g two-hour fasting oral glucose tolerance test at four to 12 weeks postpartum.

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