Am Fam Physician. 2025;112(4):368
In adults with atrial fibrillation taking apixaban or rivaroxaban, does the serious bleeding risk increase based on rate control agent choice?
According to a government-funded cohort study, adults with atrial fibrillation who take apixaban (Eliquis) or rivaroxaban (Xarelto) for stroke prevention are at a significantly increased risk of serious bleeding with the concurrent use of diltiazem compared with metoprolol for rate control. The risk is highest in patients taking diltiazem doses higher than 120 mg/day, those with a HAS-BLED (hypertension, abnormal kidney and liver function, stroke, bleeding risk, labile international normalized ratio, elderly [older than 65 years], drug and alcohol use) score of 4 or higher, and those taking rivaroxaban compared with apixaban.
What is the next step after an initial positive PSA test?
After a positive prostate-specific antigen (PSA) test result (> 4 ng/mL [4 mcg/L]), the test should be repeated in a few months to rule out laboratory error while also considering transient or treatable causes of PSA elevation (eg, prostatitis, benign prostatic hyperplasia, recent ejaculation, vigorous exercise).
How effective is vitamin E for Alzheimer dementia?
There is no evidence that vitamin E benefits cognition or slows progression in patients with mild cognitive impairment or dementia, but it may offer an adjunctive benefit with cholinesterase inhibitors, slowing cognitive decline in mild to moderate Alzheimer dementia.
What are the best return to activity steps following a sports-related concussion?
According to the 6th International Conference on Concussion in Sport, relative rest, with reduced screen time and limited activities of daily living, is recommended immediately and for the 2 days following a concussion. Light physical activity is suggested in the first 24 to 48 hours if symptoms are not significantly exacerbated with activity. Progressive return to more intense activity is recommended as long as any symptom exacerbation remains mild and brief.
What initial intervention is recommended for suspected melanoma?
All suspicious pigmented skin lesions should undergo excisional biopsy deep enough to prevent transection of the base of the lesion and include 1- to 3-mm circumferential margins excising the entire lesion.
When should DMARDs be initiated after a diagnosis of rheumatoid arthritis?
Initiate disease-modifying antirheumatic drugs (DMARDs) as soon as possible after a rheumatoid arthritis diagnosis because DMARD therapy has been shown to reduce the risk of long-term joint damage.
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