Thank you, Julia! We started this to help people understand how medical evidence, of the highest level, is generated and where recommendations come from.
I don't understand ... The authors did a subgroup analysis for the patients with stroke or TIA in the past medical history and in those patients it was harmful to give prasugrel and this is now in the guidelines. The problem with the Subgroups...In the Subgroup of women for example the primary end point was not met. For the safety end-point we don't know. Then why do we give Prasugrel in women? Iwould like to hear your opinion on this one.
Hi Manos, Andrew here. It's a good question. For me personally, whenever looking at subgroup effects I judge them on an individual basis. In my opinion, things like the difference in event rates, size of the effect, and strength of interaction influence my thinking. In this case, the concern was expressed by the authors themselves and has not been significantly challenged by the cardiology EBM community, for what it's worth. In general, I'm more open to considering subgroups effects than most in cardiology EBM community because I personally believe that HTE is normal in clinical medicine and not an exception.
Thank you for your answer. I have to admit though, that (as a cardiology resident with love to evidence based medicine but little experience on critical apraisal of trials) it is a difficult task.
Wow this was extremely interesting. How did you start doing research on the trials?
Thank you, Julia! We started this to help people understand how medical evidence, of the highest level, is generated and where recommendations come from.
I don't understand ... The authors did a subgroup analysis for the patients with stroke or TIA in the past medical history and in those patients it was harmful to give prasugrel and this is now in the guidelines. The problem with the Subgroups...In the Subgroup of women for example the primary end point was not met. For the safety end-point we don't know. Then why do we give Prasugrel in women? Iwould like to hear your opinion on this one.
Hi Manos, Andrew here. It's a good question. For me personally, whenever looking at subgroup effects I judge them on an individual basis. In my opinion, things like the difference in event rates, size of the effect, and strength of interaction influence my thinking. In this case, the concern was expressed by the authors themselves and has not been significantly challenged by the cardiology EBM community, for what it's worth. In general, I'm more open to considering subgroups effects than most in cardiology EBM community because I personally believe that HTE is normal in clinical medicine and not an exception.
Thank you for your answer. I have to admit though, that (as a cardiology resident with love to evidence based medicine but little experience on critical apraisal of trials) it is a difficult task.
You are not alone in feeling that way. Thanks for following!