Coumadin Blogs This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

There is a health care disparity in human genetics
Although we are all very similar, there are genetic differences between us that can affect our health. In different populations, people share different frequencies of certain genes. These gene variants can explain differences in medication responses, incidence of disease, and protection from illness. For example, warfarin is a widely prescribed medication that is used to prevent clotting and ischemic stroke. The dosing of this medication was previously generic and does not account for differences in different populations. This can be dangerous considering the medication is used to prevent a fatal or debilitating incident. ...
Source: Kevin, M.D. - Medical Weblog - October 12, 2015 Category: Journals (General) Authors: Dr. Mary Tags: Conditions Genetics Source Type: blogs

Possible clot issue on replacement aortic valves slows momentum of TAVR
The next frontier in cardiology is the replacement of cardiac valves via catheters rather than open-chest surgery. This new branch of cardiology is called “structural” cardiology. Trainees do entire “structural” fellowships in which they learn to do things with catheters that surgeons once did with open chest techniques. You may have heard about TAVR–or transcatheter aortic valve replacement. This procedure was pioneered in Europe, and now more than 200,000 cases have been done worldwide. We have a nascent but successful TAVR program at my hospital. In the US, TAVR is approved only for patient...
Source: Dr John M - October 10, 2015 Category: Cardiology Authors: Dr John Source Type: blogs

Research and Reviews in the Fastlane 099
This study took a sample from healthy pregnant patients (n=760) at different stages of gestation. They found, unsurprisingly, that d-dimer increases with gestational age, congruent with limited prior literature. They propose a continuous increasing d-dimer in pregnancy. With PE experts such as Dr. Kline proposing gestation adjusted d-dimer, this is a research space to watch. Recommended by: Lauren Westafer Systems and administration Del Portal DA, et al. Impact of an Opioid Prescribing Guideline in the Acute Care Setting. J Emerg Med 2015. PMID: 26281819 As many EDs implement voluntary opioid prescribing guidelines, this...
Source: Life in the Fast Lane - September 9, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 098
This study compared appropriate doses for PCC (bebulin) vs. FFP (10ml/kg) vs. FFP+PCC. All patients received Vit K. There were no differences between PCC and FFP related to time to correct INR or vascular complications. Interestingly there was a significantly lower rate of death and re-bleed on the PCC group. The expected difference on speed of correction was not seen by the outcomes were significantly better with PCC, is it time to adopt it as standard of care? Recommended by: Daniel Cabrera Emergency Medicine Beam DM et al. Immediate Discharge and Home Treatment With Rivaroxaban of Low-risk Venous Thromboembolism Diagno...
Source: Life in the Fast Lane - September 2, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine Emergency Medicine Update Haematology Intensive Care Laboratory R&R in the FASTLANE Renal Toxicology and Toxinology Urology EBM literature research and reviews Source Type: blogs

Most Don't Need'Bridging' When They Stop Warfarin Temporarily
In this study, Ortel ' s team randomly assigned patients to take either heparin or an inactive placebo during that time window. In the end, heparin showed no effect on blood-clot risk. Just 0.3 percent of treated patients developed a clot within a month of their procedure, versus 0.4 percent of patients given the placebo, the study found. < s...
Source: Medical Hemostat - August 26, 2015 Category: Medical Equipment Authors: hemostatguy at gmail.com (hemostat guy) Source Type: blogs

Most Don't Need 'Bridging' When They Stop Warfarin Temporarily
In this study, Ortel's team randomly assigned patients to take either heparin or an inactive placebo during that time window.In the end, heparin showed no effect on blood-clot risk. Just 0.3 percent of treated patients developed a clot within a month of their procedure, versus 0.4 percent of patients given the placebo, the study found.On the other hand, heparin did boost the odds of serious bleeding. Just over 3 percent of patients developed "major" bleeding, compared with just over 1 percent of placebo patients, the study found.The findings suggest that bridging is unnecessary for most atrial fibrillation patients, Ortel ...
Source: Medical Hemostat - August 26, 2015 Category: Medical Equipment Authors: hemostatguy at gmail.com (hemostat guy) Source Type: blogs

August Man of the Month: Dr. Timothy Harlan
Today begins our Culinary Nutrition Series, through next Wednesday we will be running posts from experts who will explore the relationship between food and health. Bon appetit! With an August theme of The Link Between Food and Health, Dr. Timothy Harlan was the natural choice as one of the two Disruptive Women in Health Care’s Man of the Month. While many physicians have developed an interest in food, Dr. Harlan was a chef and restauranteur first, and then developed an interest in medicine. As he puts it, “I kind of took a wrong turn” on his way to college for a hotel and restaurant management degree and wound up...
Source: Disruptive Women in Health Care - August 24, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Food Man of the Month Nutrition Source Type: blogs

August Men of the Month: Dr. Timothy Harlan & Chef Bill Barum
Today begins our Culinary Nutrition Series, through next Wednesday we will be running posts from experts who will explore the relationship between food and health. Bon appetit! In August we have the pleasure of naming two Men of the Month, the first Dr. Harlan (post below) and the second Chef Bill Barum (see his post here). With an August theme of The Link Between Food and Health, Dr. Timothy Harlan was the natural choice as one of the two Disruptive Women in Health Care’s Man of the Month. While many physicians have developed an interest in food, Dr. Harlan was a chef and restauranteur first, and then developed an in...
Source: Disruptive Women in Health Care - August 24, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Food Man of the Month Nutrition Source Type: blogs

Novel oral anticoagulants – NOACs
Warfarin is the standard oral anticoagulant in use for a long time. But there are a quite a few disadvantages for warfarin in spite of its reasonable efficacy. Most important is the unpredictable biological action needing frequent monitoring of anticoagulant efficacy with prothrombin time international normalized ratio (PT-INR) monitoring. This often means travel to a distant laboratory and hospital for individuals staying far from a tertiary care centre. Innumerable drug – drug and food – drug interactions of warfarin makes it quite difficult even for an experienced physician to the monitor warfarin on long te...
Source: Cardiophile MD - July 17, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

Funtabulously Frivolous Friday Five 109
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 109 Question 1 A friend casually remarks that she has an afternoon appointment with Doctor Fish, and asks you if you’ve heard anything about them. You caution her that…? + Reveal the Funtabulous Answer expand(document.getElementById('ddet672869585'));expand(document.getElementById('ddetlink672869585')) Doctor Fish Otherwise known as Garra rufa, are used in ‘fish foot spas‘ (nibbling off dead skin) ...
Source: Life in the Fast Lane - June 26, 2015 Category: Emergency Medicine Authors: Niall Hamilton Tags: Frivolous Friday Five dermographism Edward Jenner FFFF Fish spa LITFL rat warfarin zombies Source Type: blogs

NOACs instead of warfarin
Should more people be taking NOACs instead of warfarin?Related items from OnMedicaTime to rethink 4.5h window for alteplase after strokeUS doctor says FDA should have withdrawn rosuvastatinDigoxin linked to heightened risk of death in patients with heart problemsStatins and dietary changes have saved 20,000 livesTest could tackle underdiagnosis of MI in women (Source: OnMedica Blogs)
Source: OnMedica Blogs - June 23, 2015 Category: Journals (General) Source Type: blogs

Research and Reviews in the Fastlane 088
This article seeks to protocolize this modality into 5 specific assessments (the “5Es”): Pericardial Effusion, Qualitative Left Ventricular Ejection Fraction, Ventricular Equality, Exit (Aortic Root measurement/assessment) and Entrance (IVC diameter and respirophasic variation). This approach is a nice way to remind clinicians of all the areas EP FOCUS can assess. The article also highlights a number of pitfalls that can lead to misdiagnosis that are critical to understand. Recommended by Anand Swaminathan Critical CareJovin TG et al. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke. NEJM 20...
Source: Life in the Fast Lane - June 17, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: R&R in the FASTLANE critical care Education Emergency Medicine examination Intensive Care research and reviews Source Type: blogs

Antithrombotic for giant coronary aneurysm – Cardiophile MCQ
Most common anti thrombotic regimen for giant coronary aneurysms in Kawasaki disease: a) Low dose aspirin alone b) Low dose aspirin + warfarin c) Low molecular weight heparin d) Unfractionated heparin Correct answer: b) Low dose aspirin + warfarin Giant coronary aneurysms in Kawasaki disease have a high risk of thrombosis. Most commonly used treatment is low dose aspirin along with dose adjusted Warfarin. Aneurysms with proximal and distal stenoses have a higher chance of thrombosis due to higher platelet activation by shear stress at the stenosis and eddy currents within the aneurysm. Presence of a chronic thrombus withi...
Source: Cardiophile MD - June 3, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Venous thromboembolism in cancer – Cardiology MCQ
Which of the following cancer has the highest relative risk of venous thromboembolism? a) Pancreatic cancer b) Brain cancer c) Multiple myeloma d) Colonic cancer Correct answer: c) Multiple myeloma Multiple myeloma has forty six fold risk of venous thromboembolism than healthy controls while brain cancer has twenty fold and pancreatic cancer sixteen fold relative risk. But by absolute numbers, most episodes occur with lung, colon and prostate cancer [1]. Chemotherapy confers six fold extra risk though chemotherapy per se is not considered an indication for prophylactic anticoagulation in ambulatory patients, the exceptio...
Source: Cardiophile MD - June 2, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

A Forty-Year Struggle for Openness
In 1977, while I was busy with Star Wars and action figures, Andreas Gruentzig was using his kitchen-made balloon catheter to dilate and open a highly stenotic LAD coronary artery. Fixing atherosclerotic disease of the coronary arteries had previously required open heart bypass surgery, a procedure only 10 years old at the time. He had taken coronary catheterization, which until then had only been used for diagnostics and surgical planning, and became the first to perform transluminal interventional therapy. Unfortunately, it turned out that the coronary artery would often close either immediately or over the following day...
Source: Spontaneous Circulation - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs