Worrier In Chief
Saul couldn't have been a nicer guy. The story behind his arrival to the nursing home was long and sorted. But now we had a black gangrenous foot to deal with. The culprit, not the toe ulcer that brought him in to the hospital in the first place, but small thrombosed blood vessels from heparin induced thrombosis and thrombocytopenia, a reaction to a medication given as a precaution.
The vascular surgeon was equivocal, amputation versus watchful waiting. Toes can autonecrose (self amputate), but when the black tide of dead tissue spread towards the ankle our options became limited. As the white count began to rise, I had t...
Source: In My Humble Opinion - September 5, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Disappointing Results with Dabigatran for Mechanical Valves
Despite being more durable than bioprosthetic valves, mechanical heart valves are often not chosen because of the requirement for lifelong anticoagulant therapy. It has been hoped that the newer generation of oral anticoagulants might eventually replace warfarin, making anticoagulation more tolerable and better accepted, since these agents don’t require continuous monitoring and have much fewer serious interactions with other drugs and food. So far, however, there has been no convincing demonstration that the the newer agents are as safe and effective as warfarin for this indication. RE-ALIGN was a phase 2 dose-valid...
Source: CardioBrief - September 1, 2013 Category: Cardiology Authors: Larry Husten Tags: Uncategorized Anticoagulant Artificial heart valve dabigatran European Society of Cardiology new england journal of medicine RE-ALIGN warfarin Source Type: blogs
Positive Results for New Anticoagulant From Daiichi Sankyo
A new entrant in the growing oral anticoagulant field shows promise for the treatment of venous thromboembolism (VTE) and pulmonary embolism (PE). The drug, edoxaban, is a new, once-daily Factor Xa inhibitor with a rapid onset of action that is under development by Daiichi Sankyo. Results of the Hokusai-VTE trial were presented at the European Society of Cardiology meeting in Amsterdam and published simultaneously in the New England Journal of Medicine. The Hokusai-VTE investigators randomized 4921 patients with VTE and 3319 patients with PE to either warfarin or edoxaban. The trial differed from some earlier trials w...
Source: CardioBrief - September 1, 2013 Category: Cardiology Authors: Larry Husten Tags: Uncategorized Anticoagulant Daiichi Sankyo European Society of Cardiology new england journal of medicine pulmonary embolism VTE Source Type: blogs
Common sense as an Interventional Tool : A case of CTO of Left Pulmonary artery !
A 25 year man , hotel manager who had a documented DVT , since 2011 was on tablet warfarin . He discontinued the drug by sheer miscommunication as he was told he should stop the drug beyond INR 3 by his general practitioner.He stopped it permanently instead of titrating the dose of warfain .Six months later he landed in August 2013 with an episode of minor hemoptysis . Clincally he was normal .His lower limbs were fine.
He was investigated and his image file showed .
Living with one lung
He is comfortable with one lung function (Akin to Pneumonectomy )
His saturation was 100 % at room air
Pulse -80/...
Source: Dr.S.Venkatesan MD - August 30, 2013 Category: Cardiology Authors: dr s venkatesan Tags: acute pulmonary embolism chronic pulmoanry embolism cto of pulmonary artery deep vein thrombosis ivc filter pulmonary angiogram Source Type: blogs
A statistical joke called “Non-Inferiority” drug trial !
Of late many drugs are entering the market for human consumption backed up by Non -Inferiority trials (NIT ) .Few examples.
“The ONTARGET trial: Telmisartan is non-inferior to Ramipril in New Study Results Published in the New England …”
“Feb 20, 2013 – … in the New England Journal of Medicine Show Dabigatran Etexilate ... daily was non-inferior to warfarin (p=0.01) in preventing recurrent VTE, …”
What is the logic behind these Non inferiority trials ?
Why it came into vogue ?
Do you agree with the concept of NIT ?
Take Our Poll
I have taken the privilege...
Source: Dr.S.Venkatesan MD - August 27, 2013 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology-Statistics Uncategorized gimmicks in medical statistics non inferiority clinical trials Non inferiority drug trials Source Type: blogs
ICD/pacemaker implantation: Continued warfarin outperforms bridging with LMWH
The seemingly counterintuitive results of the BRUISE trial—which show that continued anticoagulation using warfarin is better than bridging with low-molecular-weight heparin (LMWH)--remind us of the ever-evolving nature of medicine. (Source: Blogs@theHeart.org)
Source: Blogs@theHeart.org - August 19, 2013 Category: Cardiology Authors: theheart.org Tags: Clotblog with Dr Samuel Goldhaber Source Type: blogs
Do you know this man?
I was flipping through the Washington Post today and noticed this advertisement on the back page of the first section, probably the most expensive location in the newspaper. It is an ad for Eliquis, a blood thinning agent for people with atrial fibrillation that is presented as an alternative to warfarin. I make no judgment about the relative efficacy of the drug compared to others, but I was drawn to the question of why Bristol-Myers Squibb chose this particular male model to represent its product.What is it about this image that someone has concluded will draw people to ask their doctor to prescribe this medi...
Source: Running a hospital - July 31, 2013 Category: Health Managers Source Type: blogs
Prothrombin complex concentrate better than fresh frozen plasma for urgent warfarin reversal
Prothrombin complex concentrate (PCC) better than fresh frozen plasma (FFP) for urgent warfarin reversal – says a recent article published in Circulation [Hickey M et al. Outcomes of Urgent Warfarin Reversal With Frozen Plasma Versus Prothrombin Complex Concentrate in the Emergency Department. Circulation. 2013;128:360-364]. It was a before-after study in which those who received fresh frozen plasma for urgent warfarin reversal in the emergency department between 2006-2008 and those who received prothrombin complex concentrate from 2008-2010 were compared. The primary outcome evaluated was the occurrence serious adve...
Source: Cardiophile MD - July 30, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Source Type: blogs
New echo study raises questions; aspirin often added to warfarin in AF without CAD, despite bleeding risk; two types of pulmonary hypertension respond to novel agent; diovan data-manipulation scandal in Japan
(Source: Blogs@theHeart.org)
Source: Blogs@theHeart.org - July 29, 2013 Category: Cardiology Authors: theheart.org Tags: This week in cardiology from heartwire Source Type: blogs
New echo study raises questions; aspirin often added to warfarin in AF without CAD, despite bleeding risk; two types of pulmonary hypertension respond to novel agent; Diovan data-manipulation scandal in Japan
New echo study raises questions; aspirin often added to warfarin in AF without CAD, despite bleeding risk; two types of pulmonary hypertension respond to novel agent; diovan data-manipulation scandal in Japan (Source: Blogs@theHeart.org)
Source: Blogs@theHeart.org - July 29, 2013 Category: Cardiology Authors: theheart.org Tags: This week in cardiology from heartwire Source Type: blogs
How Many Hospital Emergency Room Staffers Does it Take to Bandage a Toe? Eleven
My foot doctor pared my toe callous too deeply. Being on Coumadin, the bleeding would not stop. At the hospital emergency room, I was treated very nicely, but I was amazed at the inefficiency of the staff.Contributor: Stewart LodgePublished: Jul 21, 2013 (Source: Most Recent Health Wellness - Associated Content)
Source: Most Recent Health Wellness - Associated Content - July 22, 2013 Category: Other Conditions Source Type: blogs
