Hospital practice (1995)
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Hospital practice (1995) · Feb 2013
ReviewBleeding risk assessment in patients with atrial fibrillation who are taking oral anticoagulants.
Prevention of thromboembolism is the key priority in the management of patients with atrial fibrillation (AF). Clinical decisions on antithrombotic management should be based on the balance between an individual's thromboembolic and hemorrhagic risk. The HAS-BLED score is a simple and user-friendly tool for the assessment of bleeding risk. ⋯ Patients at high risk for stroke (CHA2DS2-VASc score ≥ 2) and hemorrhage (HAS-BLED score ≥ 3) seem to gain significant benefit from oral anticoagulants. As a general rule, oral anticoagulants should be considered for all patients with AF, except those at very low risk for stroke (CHA2DS2-VASc score of 0) and those at extremely high risk for bleeding. The newer oral anticoagulants (eg, dabigatran, rivaroxaban, and apixaban) are promising alternatives to vitamin K antagonists for the prevention of stroke in patients with nonvalvular AF.
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Hospital practice (1995) · Feb 2013
Evaluation of the utility of the Wells score in predicting pulmonary embolism in patients admitted to a spine surgery service.
A retrospective medical chart review of 4179 patients admitted to the spine surgery service. ⋯ The results of the CTPA did not show a significant correlation with the Wells score or the reason for the test. Our findings indicate the need to develop a predictive scoring system that assesses the risk of PE and assists in the decision-making process for ordering CTPA in spine surgery patients.
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Hospital practice (1995) · Feb 2013
ReviewNovel oral anticoagulants: a review of the literature and considerations in special clinical situations.
Novel oral anticoagulants (OACs), including dabigatran etexilate, rivaroxaban, and apixaban, are available alternative anticoagulant therapy to vitamin K antagonists. The US Food and Drug Administration (FDA) has approved dabigatran, rivaroxaban, and apixaban for the treatment of appropriate patients for specific clinical indications. Therapeutic advantages of prescribing the new OACs are related to their predictable pharmacokinetic and pharmacodynamic properties. ⋯ Dabigatran, rivaroxaban, and apixaban are all approved agents for stroke prevention in patients with nonvalvular atrial fibrillation in the United States and Europe. Among these agents, rivaroxaban is the only FDA-approved drug for the treatment of venous thromboembolism. This article reviews the major clinical trials that investigated the efficacy and safety of the new OACs and the use of these agents in special clinical situations.
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Hospital practice (1995) · Feb 2013
ReviewNovel oral anticoagulants for stroke prevention in patients with atrial fibrillation.
Patients with atrial fibrillation (AF) face an elevated risk of stroke compared with patients who have normal sinus rhythm. Warfarin, an oral vitamin K antagonist, is a highly effective therapeutic agent to reduce stroke risk in patients with AF; however, use of warfarin is complicated by variable patient dose response due to genetic factors and multiple food-drug and drug-drug interactions. ⋯ More recently, the US Food and Drug Administration (FDA) approved 2 oral activated factor X inhibitors, rivaroxaban and apixaban, for stroke prevention in patients with AF based on clinical trial evidence of their safety and efficacy. In this article, we provide an overview of the 3 novel oral anticoagulants for treating patients with AF and discuss the latest findings from subgroup analyses.
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Hospital practice (1995) · Feb 2013
ReviewDual antiplatelet therapy with aspirin and clopidogrel: what is the risk in noncardiac surgery? A narrative review.
Clopidogrel is one of the most commonly prescribed medications and is currently recommended along with aspirin as treatment to be used for 1 year in all patients without contraindications following an acute coronary syndrome. Patients who are committed to clopidogrel therapy due to recent coronary artery stent implantation may require noncardiac surgery during this recommended period of dual antiplatelet therapy (DAPT). Due to differing rates of endothelialization, patients who undergo bare-metal stent implantation generally require ≥ 1 month of uninterrupted DAPT, and those who undergo drug-eluting stent implantation require ≥ 12 months. ⋯ References from extracted articles were also reviewed for relevant articles. Literature regarding perioperative clopidogrel continuation is predominantly composed of small, nonrandomized data, but suggests that most noncardiac surgeries or procedures can be performed safely while patients are taking clopidogrel. In this article, we review the current best evidence on the risk for bleeding with clopidogrel therapy in noncardiac surgery, summarize recent guidelines on appropriate duration of DAPT, and make recommendations on the management of perioperative DAPT.