Choosing the Right Drug: Non-Opioids for Acute Pain & Edoxaban for Venous Thromboembolism


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This week on The Rounds Table we are covering two important articles: the first examining combination opioids versus non-opiods for acute pain, and the second examining the use of edoxaban to treat cancer-associated venous thromboembolism (VTE). Kieran Quinn and Paxton Bach break it down for listeners.

Opioid addiction is arguably the biggest epidemic of our time. No matter what statistics you use to frame it, a major contribution has been physician prescription. Paxton takes listeners through a randomized controlled trial showing that in patients presenting to the emergency room with acute extremity pain there is no difference between oral opioid and non-opioid combinations of analgesics for pain control.

Kieran then takes the lead to discuss anticoagulation in patients with cancer. Low molecular weight heparin (LMWH) is the gold standard treatment for cancer associated venous thromboembolism. No trial has directly compared the newer anticoagulants with LMWH. Kieran guides listeners through a trial showing that edoxaban, a direct oral anticoagulant, is non-inferior when compared to LMWH with respect to recurrent VTE or the development of major bleeding over a 1 year period.

Finally, the Good Stuff segment. Kieran shares an article showing that words can hurt. Literally. Paxton shares an article on buying opioids online.

If you like what you hear, rate us on iTunes! Chat with us on Twitter @roundstable and tweet at Kieran @kieranlquinn and Paxton @paxbach 

The Papers

1. Edoxaban & VTE: http://www.nejm.org/doi/full/10.1056/NEJMoa1711948

2. Opiods vs. Non-Opiods for Acute Extremity Pain: https://jamanetwork.com/journals/jama/article-abstract/2661581?redirect=true

Good Stuff

1. Words Can Hurt: https://jamanetwork.com/journals/jama/fullarticle/2661032

2. Opioid Dealers: https://www.nytimes.com/2017/06/10/business/dealbook/opioid-dark-web-drug-overdose.html

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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