New Data Increase Caution on Left Atrial Appendage Occlusion
This study took data from more than 61 centers across the world.
The details of the studies are included in my column: Real-World Data on Left Atrial Appendage Closure Does Not Reassure
The gist of these studies was that clots on the device are not rare; potent clot-protecting drugs are likely required to prevent clots (at least for a period of weeks-months); the presence of clots increase the risk of stroke, and finally, major procedural complications are in the range of 4%.
These findings bolster my already cautions approach to this procedure.
Remember, left atrial appendage closure is a preventive procedure. Its benefi...
Source: Dr John M - June 27, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
Whether or Not Republicans Are Able to Replace Obamacare …
By MEGAN ADAMSON
… There is a far more fundamental issue affecting the overall success of our healthcare system. Doctors and patients need more transparency when it comes to health care costs.
Healthcare is becoming more expensive by the year. In 1960, healthcare costs accounted for 5% of the gross domestic product. In 2015, they made up 17.8 percent. Although the rates of spending growth actually decreased since 2010 when the Affordable Care Act was enacted, a recent study demonstrated that for employees under 65 with employer sponsored health insurance, the proportion of income consumed by health insurance premiu...
Source: The Health Care Blog - June 25, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
The Top 10 Trends Shaping the Future of Pharma
The drug sends a message to a caregiver after the patient swallowed it. The doctor prescribes virtual reality treatments for migraines. Do you think it is science fiction? You are mistaken. Just let me familiarize you with the top 10 trends shaping the future of pharma.
I gave a speech recently to an audience of professionals working in healthcare regulation for the invitation of the Consumer Healthcare Products Association in Washington. After the keynote, a guy raised his hand and asked me the following: how can a regulatory agency keep up with the speed of new technologies in pharma? I get a lot of questions like this o...
Source: The Medical Futurist - June 20, 2017 Category: Information Technology Authors: nora Tags: Future of Medicine Future of Pharma 3d printing artificial intelligence augmented reality digital health gc4 Innovation nanotechnology Personalized medicine pharmacies pharmacogenetics pharmacology virtual reality VR Source Type: blogs
4-factor PCC versus FFP to reverse warfarin in CNS bleeds
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - June 4, 2017 Category: Internal Medicine Tags: hematology neurology pharmacology Source Type: blogs
Dabigatran versus warfarin and the risk of AKI
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - May 25, 2017 Category: Internal Medicine Tags: cardiovascular nephrology pharmacology Source Type: blogs
How important are short AF episodes?
A study presented at the recent Heart Rhythm Society meeting in Chicago has added more uncertainty about the significance of short-duration AF episodes.
Before I tell you about the study, I need to clarify what I mean by short-duration AF episodes, sometimes called subclinical AF (SCAF).
SCAF is AF on a monitor that is often not felt by the patient. Doctors are seeing more of this because patients are increasingly being monitored–with pacemakers, ICDs, long-term event recorders and implantable cardiac monitors. These devices can pick up minute-long or hour-long AF episodes.
In the past, AF could only be picked up whe...
Source: Dr John M - May 25, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
Statins, Like All Medicines, Are Neither Good Nor Bad
We have to talk about drugs.
No, not illicit drugs, but medications used by doctors and patients.
Plaintiff attorneys run ads on TV that fool people into thinking certain meds are bad. The current one I deal with is the clot-blocking drug rivaroxaban (Xarelto.) Before that, it was dabigatran (Pradaxa). If, or when, the makers of rivaroxaban settle a class action suit, you can bet apixaban (Eliquis) will be next.
These ads are a problem because they use fear persuasion (see Scott Adams’ blog), and because they can induce patients to stop taking or not starting a beneficial medicine.
Lots of other medications suffer ...
Source: Dr John M - April 30, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
Should You Take an Anticoagulant for AF? — Applying the 4 questions
This study of nearly 1000 elderly AF patients found that the risk of major bleeding was not different between aspirin and warfarin. I, therefore, side more with the European guidelines. Aspirin confers significant bleeding with either no or minimal stroke prevention effects.
4. What happens if I do nothing?
This is easy. For the patients above, who have two risk factors, the green faces depict what happens if they do nothing. The most likely scenario is that they will not have a stroke (approx 97%) and not have a bleed (98%).
The North American AF treatment guidelines grade the strength of their recommendations. They give ...
Source: Dr John M - April 18, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
Small Clots on Replacement Aortic Valves Deserve Attention
This study, like all good studies, raises many questions for future study. I look forward to learning more about this issue.
This discovery also highlights the challenge of making progress in cardiology. It’s hard work. I may be wrong, but it’s likely we are in a period of slow incremental progress.
JMM
Related posts:
Possible clot issue on replacement aortic valves slows momentum of TAVR
Why shouldn’t Cardiology lead the way in shared decsion-making?
The top three Cardiology stories of 2010…and three predictions for 2011 (Source: Dr John M)
Source: Dr John M - April 6, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
MKSAP: 81-year-old man after a percutaneous coronary intervention
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. Medical history is significant for hypertension and type 2 diabetes mellitus. He has no risk factors for or history of significant bleeding. Medications are aspirin, clopidogrel, lisinopril, ...
Source: Kevin, M.D. - Medical Weblog - March 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
Can a Genetic Test Tell You What Medication to Take For a Headache? The MyDNA Review
I was offered a genetic test by MyDNA that promises to let you know how your body metabolizes medications based on your genetic background. It might be crucial in the future when deciding about certain drugs for certain diseases. Here, I show you the results of my review.
Reading the secrets of your body with genetic testing
As a researcher with a PhD in genomics, it is fascinating for me to see how genetic tests work in action. The feeling of getting the results is similar to that if you could peek into a secret world, as if you could read the Rosetta Stone’s ancient old Egyptian hieroglyphs. The difference is that in t...
Source: The Medical Futurist - March 8, 2017 Category: Information Technology Authors: nora Tags: Genomics Personalized Medicine DNA dna testing dosing drug future gc3 Genetic testing genetics Genome Innovation pharma pharmacogenetics Source Type: blogs
My latest on the NOAC drugs for AFib
Three weeks ago I wrote about the growing dominance of the new oral anticoagulant (NOAC) drugs for stroke prevention in patients with atrial fibrillation. (Another common name for these drugs is direct acting oral anticoagulants or DOACs.)
The post generated many comments–some privately and some on the blog.
Your responses induced me to think a bit more about the warfarin-substitute drugs. Thanks for that.
More thinking led to my most recent post on theHeart.org, which is titled: NOACs Are Favored Over Warfarin: I’m (Almost) Okay With That
In this column, which is written for a medical audience, I start by noti...
Source: Dr John M - March 3, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
2017 update on the changing use of “blood thinners” for AF
Times have changed in the treatment of patients with atrial fibrillation (AF).
First some background: The first of the four pillars of AF care is stroke prevention. The only proven means to protect patients with AF from stroke is use of drugs that block clotting factors–or anticoagulants.
Some people call these drugs blood thinners. I don’t. That’s because they don’t thin the blood. They inhibit proteins in the blood that form clots; viscosity of the blood is not affected. Blockade of clotting factors works because static blood in the fibrillating (non-contractile) atria increases the probability of...
Source: Dr John M - February 13, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
In Which I Go Under The Knife And Learn About Medicine In The Real World
I’m not a doctor but I thought I knew something about anticoagulation. Over the course of a career covering cardiology I’ve written countless stories about heparin, warfarin, the low molecular weight heparins, and the new oral anticoagulants. So when I had bilateral total knee replacement a few weeks ago I thought I knew what to...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - January 27, 2017 Category: Cardiology Authors: Larry Husten Tags: People, Places & Events Policy & Ethics anticoagulation aspirin Evidence-based medicine Lovenox total knee replacement Xarelto Source Type: blogs
Understanding head injuries
Ski season is here, and I am reminded of the story of Natasha Richardson (Liam Neeson’s wife), who tragically died of a head injury while skiing without a helmet in 2007. Here in the emergency department, we see many patients with concern for head injuries. We factor what may have caused the injury, your age, what we find when we examine you, the timing of the incident, the medicines you take, as well as some other factors, when deciding whether to do a CT scan or admit you to the hospital.
When a head injury causes bleeding in the brain
Ms. Richardson died of an epidural hematoma, one of several types of brain bleeding,...
Source: Harvard Health Blog - January 18, 2017 Category: Consumer Health News Authors: Jonathan Nadler, MD Tags: Brain and cognitive health Injuries Prevention Safety Source Type: blogs
