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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CONCLUSIONS: Overall, results of secondary analyses indicate that the recommended dosing strategy for each of the DOACs produces a consistent anticoagulant effect across a diverse patient population, including those at increased risk of stroke or bleeding. PMID: 30081727 [PubMed - in process]
Source: Adv Data - Category: Epidemiology Authors: Tags: Ther Adv Cardiovasc Dis Source Type: research
AbstractAtrial fibrillation (AF) and cancer are common disorders in the general population but there are few studies in patients with both diseases. More specifically, there are scarce data on AF in patients with non-Hodgkin lymphoma (NHL). We assessed the incidence, predictive factors, management, and survival impact of AF in a cohort of patients with NHL from a single institution between 2002 and 2016 (n = 747). Twenty-three patients were diagnosed with AF before and 40 after the diagnosis of NHL (of the later, 16 were secondary to an extracardiac comorbidity and 24 unrelated to any triggering event [primar...
Source: Annals of Hematology - Category: Hematology Source Type: research
A 64-year-old male with paroxysmal atrial fibrillation and a recent stroke presented with internal carotid artery re-stenosis after prior angioplasty. Cardiovascular risk factors included arterial hypertension, hyperlipidemia, obesity, positive family history, heart failure, and active smoking. Due to high risk of cerebral ischemia as well as periinterventional bleeding complications, the patient was scheduled for interventional left atrial appendage (LAA) closure prior to carotid artery surgery.
Source: Heart Rhythm - Category: Cardiology Authors: Source Type: research
Publication date: March 2018Source: Advances in Medical Sciences, Volume 63, Issue 1Author(s): Ewelina Michniewicz, Elżbieta Mlodawska, Paulina Lopatowska, Anna Tomaszuk-Kazberuk, Jolanta MalyszkoAbstractCoronary 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 pati...
Source: Advances in Medical Sciences - Category: Biomedical Science Source Type: research
Publication date: Available online 27 June 2018Source: Revista Española de Cardiología (English Edition)Author(s): Maria Mahmood, Gregory Y.H. LipAbstractBoth atrial fibrillation (AF) and chronic kidney disease (CKD) are highly prevalent, especially with increasing age and associated comorbidities, such as hypertension, diabetes, heart failure, and vascular disease. The relationship between both AF and CKD seems to be bidirectional: CKD predisposes to AF while onset of AF seems to lead to progression of CKD. Stroke prevention is the cornerstone of AF management, and AF patients with CKD are at higher risk of ...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research
Publication date: March 2018Source: Advances in Medical Sciences, Volume 63, Issue 1Author(s): Ewelina Michniewicz, Elżbieta Mlodawska, Paulina Lopatowska, Anna Tomaszuk-Kazberuk, Jolanta MalyszkoAbstractCoronary 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 pati...
Source: Advances in Medical Sciences - Category: Biomedical Science Source Type: research
Publication date: Available online 27 June 2018Source: Revista Española de Cardiología (English Edition)Author(s): Maria Mahmood, Gregory Y.H. LipAbstractBoth atrial fibrillation (AF) and chronic kidney disease (CKD) are highly prevalent, especially with increasing age and associated comorbidities, such as hypertension, diabetes, heart failure, and vascular disease. The relationship between both AF and CKD seems to be bidirectional: CKD predisposes to AF while onset of AF seems to lead to progression of CKD. Stroke prevention is the cornerstone of AF management, and AF patients with CKD are at higher risk of ...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research
Individualized weighing of the risk benefit of anticoagulation is recommended in patients with atrial fibrillation (AF) who have low established risk scores or, conversely, are at increased risk for bleeding. Parameters of arterial stiffness and wave reflection could improve risk stratification, but their use has not been evaluated in arrhythmia. We measured carotid-femoral pulse wave velocity (PWV), central augmentation index (AI), and central pulse pressure (CPP) using the SphygmoCor system in 34 patients (53 to 85  years; 25 males) with AF before and after elective electrical cardioversion.
Source: Journal of the American Society of Hypertension - Category: Cardiology Authors: Tags: Research Article Source Type: research
Individualized weighing of the risk-benefit of anticoagulation is recommended in patients with atrial fibrillation (AF) that have low established risk scores or, conversely, are at increased risk for bleeding. Parameters of arterial stiffness and wave reflection could improve risk stratification, but their use has not been evaluated in arrhythmia.
Source: Journal of the American Society of Hypertension - Category: Cardiology Authors: Tags: Research Article Source Type: research
Publication date: Available online 27 June 2018 Source:Revista Española de Cardiología (English Edition) Author(s): Maria Mahmood, Gregory Y.H. Lip Both atrial fibrillation (AF) and chronic kidney disease (CKD) are highly prevalent, especially with increasing age and associated comorbidities, such as hypertension, diabetes, heart failure, and vascular disease. The relationship between both AF and CKD seems to be bidirectional: CKD predisposes to AF while onset of AF seems to lead to progression of CKD. Stroke prevention is the cornerstone of AF management, and AF patients with CKD are at higher risk of strok...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research
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