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Anticoagulant Reversal Drugs Stop Patient's Internal Hemorrhage

Pharmacology to the tune of anticoagulant reversal Your EMS flight crew is dispatched by rotor to a remote hospital in the Great Basin Desert for a patient with gastrointestinal (GI) bleeding. The patient was brought in by her grandson. She was vomiting blood as well as suffering from bloody diarrhea. On arrival, you find an 80-year-old female sitting up in a hospital bed, although she's extremely weak. She has a Glasgow coma scale (GCS) of 15 and states she's been throwing up blood all day. She appears pale but is in no obvious distress. Her vital signs are a heart rate of 100 with regular pulse; blood pressure 60/35 mmHg; respiratory rate of 20; and SpO2 of 94% with poor waveform on 2 L/min via nasal cannula. The patient's history is limited to atrial fibrillation and hypertension. Her nurse informs you that she's received 80mg Protonix (pantoprazole) and a liter of normal saline (NS). Given the patient's active GI bleed, her current blood pressure, and the 1.5 hour-plus flight to the receiving facility, you decide it's appropriate to request the hospital's only two units of packed red blood cells (PRBCs). You load the patient into the helo without difficulty. As you begin transport, you find yourselves facing a strong headwind. Your pilot says that because of this you'll have to stop for fuel on the way to complete transport. You and the crew put your heads together and decide the best course of action is to set down at your home hospital pad. This will take you off course...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Patient Care Columns Source Type: news

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Conclusion If you’ve been diagnosed with AF and you have been prescribed anticoagulant treatments such as warfarin or clopidogrel, we already know they protect you against having a stroke. This study suggests they may also help to protect you against dementia. Cutting the risk of dementia for people who have a raised risk because of AF would be an exciting step forward. Unfortunately, we can’t tell from this study whether the protection against dementia was down to the anticoagulants, because of the possible effect of unmeasured confounding factors. Usually, we would want to see a randomised controlled trial (R...
Source: NHS News Feed - Category: Consumer Health News Tags: Neurology Source Type: news
Conclusions—Performance of prediction models for major bleeding in patients with cerebral ischemia and atrial fibrillation is modest but comparable with performance in patients with only atrial fibrillation. Bleeding risk scores cannot guide treatment decisions for oral anticoagulants but may still be useful to identify modifiable risk factors for bleeding. Clinical usefulness may be best for ORBIT, which is based on a limited number of easily obtainable variables and showed reasonable performance.
Source: Stroke - Category: Neurology Authors: Tags: Atrial Fibrillation, Secondary Prevention, Ischemic Stroke Brief Reports Source Type: research
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
Our cautionary left atrial appendage occlusion (Watchman) editorial is now published in a prominent medical journal, called Heart Rhythm. My co-authors are Drs. Andrew Foy and Gerald Naccarelli from Penn State. It was a peer-reviewed version of my previous theheart.org | Medscape Cardiology column. Watchman and other similar devices are plugs that occlude the left atrial appendage in an attempt to reduce the odds of stroke in patients with atrial fibrillation. It was a nice idea but it did NOT work. The link is here> Percutaneous Left Atrial Appendage Closure is Not Ready for Routine Clinical Use In the allott...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs
In this study, we investigated the adherence to once- or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1:1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relatio...
Source: Bosnian Journal of Basic Medical Sciences - Category: General Medicine Tags: Bosn J Basic Med Sci Source Type: research
Abstract BackgroundStroke risk is a significant concern in patients with atrial fibrillation (AF). Low stroke risk patients (CHADS2VASc 0–2) are often treated long‐term with aspirin after catheter ablation. Defining the long‐term risks versus benefits of aspirin therapy, after an ablation, is essential to validate this common clinical approach. MethodsA total of 4,124 AF ablation patients undergoing their index ablation were included in this retrospective observational study. We compared 1‐ and 3‐year outcomes for cerebrovascular accident (CVA), transient ischemic attack (TIA), gastrointestinal (GI) bleeding,...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ARTICLE Source Type: research
CONCLUSIONS: At the beginning of NOAC prescriptions, European doctors tended to switch from VKAs to NOACs those patients at lower risk than "non-switchers". Complaints about bruising or bleeding, dissatisfaction with treatment, mobility problems and anxiety/depression traits appear to be related to - and may have influenced - the choice to switch from a VKA to a NOAC. PMID: 28942115 [PubMed - as supplied by publisher]
Source: Archives of Cardiovascular Diseases - Category: Cardiology Authors: Tags: Arch Cardiovasc Dis Source Type: research
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Source: Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Letter to the Editor Source Type: research
CONCLUSIONS: Concomitant closure of ASD or PFO in the presence of enlarged atria and LAA for primary primary prevention appears feasible and safe but has yet to prove its justification. PMID: 28840592 [PubMed - as supplied by publisher]
Source: Cardiology Journal - Category: Cardiology Authors: Tags: Cardiol J Source Type: research
Publication date: March 2018 Source:Advances in Medical Sciences, Volume 63, Issue 1 Author(s): Ewelina Michniewicz, Elżbieta Mlodawska, Paulina Lopatowska, Anna Tomaszuk-Kazberuk, Jolanta Malyszko Coronary artery disease (CAD) is the most common cardiovascular disease while atrial fibrillation (AF) is the most common cardiac arrhythmia. Both diseases share associated risk factors – hypertension, diabetes mellitus, sleep apnea, obesity and smoking. Moreover, inflammation plays a causative role in both diseases. The prevalence of CAD in patients with AF is from 17% to 46.5% while the prevalence of AF among patients ...
Source: Advances in Medical Sciences - Category: Biomedical Science Source Type: research
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