An Anticoagulant Antidote
Here's a drug-discovery problem that you don't often have to think about. The anticoagulant field is a huge one, with Plavix, warfarin, and plenty of others jostling for a share of a huge market (both for patients to take themselves, and for hospital use). The Factor Xa inhibitors are a recent entry into this area, with Bayer's Xarelto (rivaroxaban) as the key example so far.
But there's a problem with any Xa inhibitor: there's no antidote for them. Blood clotting therapies have a narrow window to work in - anything effective enough to be beneficial will be effective enough to be trouble under other circumstances. Anticoa...
Source: In the Pipeline - May 9, 2013 Category: Chemists Tags: Cardiovascular Disease Source Type: blogs
Atypical Chest Pain: Suspicious ECG, and a Left Main ACS is found in a 30-something
A male in his 30s presented with chest pain, cough, and sore throat.He had been seen in clinic the day prior for cough x 1 month and sort throat. A strep test was positive and he was treated with penicillin, and also with acetaminophen and ibuprofen.On the day of ED (ER) presentation, he presented with 5 hours of intermittent sudden onset left side chest pressure unrelieved by ibuprofen, with associated vomiting and SOB. There was some association with moving and palpation, but also some improvement with NTG. An ECG was obtained immediately:Sinus rhythm. There is some inferior and lateral ST elevati...
Source: Dr. Smith's ECG Blog - May 7, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
When anterior epicardial fat . . . generates Q waves . . . diagnosis of ASMI gets busted !
Q wave are neither sacred nor sinister waves . It represents either of the following .
Electrical activity that goes away from the recording electrode.
Or whenever there is a electrical insulation or hurdle that interrupts the flow of current towards the electrode ( and if it is sustained ) it can result in q waves (Minor interruption produces a notch or slurs . Please note a major slur becomes a q wave equivalent )
Here is young women of 42 years with a diagnosis of old anterior MI for over 5 years ( Getting a dedicated care from a cardiologist! The prescription included Imdur/Bet...
Source: Dr.S.Venkatesan MD - April 24, 2013 Category: Cardiology Authors: drsvenkatesan Tags: Cardiology - Electrophysiology -Pacemaker cardiology -ECG Cardiology -unresolved questions Clinical cardiology epicardial fat and q waves non infarct q waves pesdo infarct patterns in ecg Source Type: blogs
Pulmonary Edema, Hypertension, and ST Elevation 2 Days After Stenting for Inferior STEMI
A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. He had no chest pain. Medications were aspirin, clopidogrel, metoprolol, and simvastatin. He was in acute distress from pulmonary edema, with a BP of 180/110, pulse 110. Here is his prehosptial ECG:There are inferior Q-waves with ST elevation T-wave inversion. There is reciprocal ST depression in aVL and I. There is ST depression in V2 and V3, with biphasic T-waves (down-up). The computer read is: *****Acute MI*****The...
Source: Dr. Smith's ECG Blog - April 12, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
Clopidogrel and statin releoad protects against early cerebral ischemic events
ARMYA-9 CAROTID study [Patti G et al. Strategies of Clopidogrel Load and Atorvastatin Reload to Prevent Ischemic Cerebral Events in Patients Undergoing Protected Carotid Stenting: Results of the Randomized ARMYDA-9 CAROTID (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting) Study. J Am Coll Cardiol. 2013;61(13):1379-1387.] has concluded that a loading dose of 600 mg of clopidogrel and high dose atorvastatin in those undergoing carotid stenting protects against early ischemic cerebral events. The study involved over one hundred and fifty patients who underwent protected carotid stenting. Clopidogrel load...
Source: Cardiophile MD - March 31, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin Tags: Angiography and Interventions Source Type: blogs
Septal STEMI with lateral ST depression, then has collateral reperfusion resulting in Wellens' waves
A middle-aged male presented with 1.5 hours of 8/10 chest pain associated with diaphoresis and vomiting. He has a prior history of untreated hypertension and hyperlipidemia, and is a current smoker. He called 911. Prehospital vitals were normal, and there was no change in pain with 2 sublingual NTG. Here is his first ED ECG, at time zero. The preshospital ECG was identical and the computer in both cases read "nonspecific ST-T abnormalities."Zero hours. There is STE in V1 and V2, and ST depression in I, aVL, V5, and V6. Is it normal variant STE? Or is it anterior STEMI? As in a recently ...
Source: Dr. Smith's ECG Blog - March 20, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cangrelor During PCI May Reduce Ischemic Events
In the Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION PHOENIX) trial, the intravenous platelet inhibitor cangrelor was tested for its effect on ischemic events associated with PCI. Cangrelor is a potent, fast-acting and reversible agent. Results of the trial were presented at the ACC in San Francisco and published simultaneously in the New England Journal of Medicine. A total of 11,145 PCI patients were randomized to a bolus and infusion of cangrelor or to a loading dose of clopidogrel. A primary endpoint event — death, MI, ischemia-driven revascularization, or stent...
Source: CardioBrief - March 10, 2013 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery antiplatelet Cangrelor clopidogrel PCI Source Type: blogs
Is it safe to take aspirin and warfarin together?
The ultimate goal in medicine: protect the patient from stroke. Even a heart doctor has to admit the dominance of the human brain.
Always think about preventing stroke. It’s one of the worst outcomes that can happen to a person. Life as a ‘normal’ human requires a healthy brain. A stroke irreversibly kills off part of the brain. Stuff you take for granted can go away: swallowing, speaking, understanding language, sight, movement of a limb, not drooling, and the list goes on.
The most common cause of stroke is ischemic–meaning a blocked blood vessel leading to the brain or in the brain itself. A comm...
Source: Dr John M - March 7, 2013 Category: Cardiology Authors: Dr John Source Type: blogs
Why Prasugrel is contraindicated in TIA ?
Take Our Poll
Current prescribing information cautions clearly Prasugrel should not be used in TIA or recent stroke (Even in ischemic strokes -Embolic included !)
The warning is perplexing and illogical to me.
What is your take ?
I would imagine the following could be the reasons.
Prasugrel as an antiplatlet agent is many fold powerful and could convert all strokes into hemorrhagic one .
Does Prasugrel convert a TIA into stroke instead of curing it ?
Prasugrel may worsen the stroke in case the TIA is going to end up as stroke.
Is there any thing called hemorrhagic TIA ?
Since we do not have...
Source: Dr.S.Venkatesan MD - February 27, 2013 Category: Cardiology Authors: drsvenkatesan Tags: stroke Uncategorized Antipaltelet agents drugs controversy antipaltelt agents mainstay in tia prasugrel for tia prasugrel vs clopidogrel in TIA strke in evolution Source Type: blogs
Extremely Subtle ECG, but Bedside Echo Shows Wall Motion Abnormality and Ischemic Pain Cannot Be Controlled Medically
A male in his 40's with no previous cardiac history had presented to a clinic recently with chest burning, had a nondiagnostic ECG, and was diagnosed with reflux. He presented to an ED with 2.5 hours of chest burning a few days later. His BP was 152/84. Here is the initial ECG:Sinus rhythm, Q-wave in III with minimal ST elevation and minimal ST depression in I and aVL. There is a suspiciously minimally biphasic T-wave in V6. This is a nonspecific ECG.The ECG from the clinic was sought for comparison:Compared to this one, the ST depression in I and aVL seen above is new and T-waves are nonspeci...
Source: Dr. Smith's ECG Blog - February 21, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
No More Financial Assistance for Plavix from Bristol-Myers But Are Generics Really the Same?
Bristol-Myers Squibb (NYSE: BMY) is no longer offering its $37-a-month Plavix® Co-Pay Discount Card. And some patients are not happy about this. Additionally, according to the company's web site for "Patient Assistance Programs," the company is no longer making this life-saving drug available to patients who cannot afford it. This, of course, has something to do with the fact that brand-name Plavix has gone off patent and generic versions have been available since May 2012. But are the generic versions of clopidogrel really the same? (Source: Burts Stent Blog : The Voice in the Ear)
Source: Burts Stent Blog : The Voice in the Ear - February 18, 2013 Category: Health Medicine and Bioethics Commentators Source Type: blogs
The LITFL Review 095
Welcome to the challenging 95th edition!
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
The Most Fair Dinkum Ripper Beaut of the Week
emimdoc
Top spot this week heads over to David at emimdoc with his post on A Note to Conference Organiz...
Source: Life in the Fast Lane - February 18, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs
The LITFL Review 095
Welcome to the challenging 95th edition!
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
The Most Fair Dinkum Ripper Beaut of the Week
emimdoc
Top spot this week heads over to David at emimdoc with his post on A Note to Conference Organiz...
Source: Life in the Fast Lane - February 18, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs
#178: Short course of aspirin, clopidogrel cuts stroke risk; Lp(a) gene variant associated with aortic stenosis; MAGELLAN published: Rivaroxaban reduces VTE risk in acutely ill patients; weight-loss drug Qsymia improves cardiovascular risk profile
course of aspirin, clopidogrel cuts stroke risk; Lp(a) gene variant associated with aortic stenosis; MAGELLAN published: Rivaroxaban reduces VTE risk in acutely ill patients; weight-loss drug Qsymia improves cardiovascular risk profile (Source: Blogs@theHeart.org)
Source: Blogs@theHeart.org - February 15, 2013 Category: Cardiology Authors: theheart.org Tags: This week in cardiology from heartwire Source Type: blogs
Lipitor & Plavix: The Last of the Small Molecule Best Sellers?
Forbes just published a list of "Best Selling Drugs of All Time" (see here). I created the following chart from the data cited (click on it for a larger view):"Tellingly," notes the Forbes author, Simon King, "each of the products in the list above best positioned to record an increase in peak annual sales over the next five years is a biologic; Humira, Enbrel, Rituxan, Herceptin and Lantus being the chief candidates. This is driven by a number of factors – the later launch of certain brands, for example – but also illustrates the robustness of leading biologic franchises that do not face direct substitutable generic c...
Source: Pharma Marketing Blog - January 28, 2013 Category: Pharma Commentators Tags: Drug prices Plavix Humira Lipitor Pfizer drug pipeline orphan drugs Blockbuster Source Type: blogs
