Minimum duration 15 mg iso bupiv with epi
Oral board type case: Knee removal of antibiotic spacer, placement of new implant. Obese, COPD/asthma, MH susceptible, on Coumadin (held) INR 1.2. Prefer to do spinal MAC, AWARE I COULD do CSE but seems like a pain in her and INR 1.2. So... a big boy dose of iso bupiv 12-15 mg with epi and narcotic should be VERY likely to last 4 hours, yes? (Haven’t used tetracaine in 20 years) (Source: Student Doctor Network)
Source: Student Doctor Network - May 14, 2020 Category: Universities & Medical Training Authors: caligas Tags: Anesthesiology Source Type: forums

Spontaneous retroperitoneal hemorrhage
If patient develops spontaneous retroperitoneal bleed from coumadin ( no injury or fall or anything) assuming Hgb and vitals are stable and remain stable for a few days. Any point in getting a repeat CT to monitor??? (Source: Student Doctor Network)
Source: Student Doctor Network - March 5, 2020 Category: Universities & Medical Training Authors: Cadet133 Tags: Internal Medicine and IM Subspecialties Source Type: forums

New hazardeous drug reqs @walg
Anyone know what happened that we now have 15 page document full of new reqs with multiple pages of new hazardeous drugs? Cant even use drivethru tube for pages and pages of new drugs such as warfarin? My word. Head hurts just thinking about this. (Source: Student Doctor Network)
Source: Student Doctor Network - November 5, 2019 Category: Universities & Medical Training Authors: Charcoales Tags: Pharmacy Source Type: forums

Back to the future? Re: Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting
(Source: BMJ Comments)
Source: BMJ Comments - July 12, 2018 Category: General Medicine Source Type: forums

What is the working life as a speciality trainee? (hours etc)
Thread Starter What is the working life as a speciality trainee? (hours etc) Follow 1 hour ago 1 hour ago Quote: Originally Posted by ecolier It reminds me of PACES revision! You would see a bunch of SHOs roaming the wards out of hours looking for "patients wit...
Source: The Student Room - May 9, 2018 Category: Universities & Medical Training Authors: junior.doctor Tags: Medicine Source Type: forums

Bridging
Please settle this debate... pt was an apixiban prior to admission for Afib. Pt admitted for chest pain, no planned procedures . MD wants to switch to Coumadin and patient’s INR =1.1. Consult was for Afib with goal of 2-3. No prior stroke/dvt/pe hx. Do you bridge or not? Sent from my iPhone using SDN mobile (Source: Student Doctor Network)
Source: Student Doctor Network - May 6, 2018 Category: Universities & Medical Training Authors: Stella14 Source Type: forums

Stopping anticoagulants, a cautionary tale
One of my favorite patients, a 93 y.o. man with a H/O Afib, had his Coumadin stopped for a Mohs procedure. It was D/C until the sutures came out. Well, he had a large stroke and is now wheelchair bound in an assisted living facility. I treat his family members and his daughter bitterly told me the story yesterday. I will miss seeing Frank but his daughter did tell me that since he is not weight bearing he is not having pain. I never had to stop his anticoagulants for RFA or joint... Stopping anticoagulants, a cautionary tale (Source: Student Doctor Network)
Source: Student Doctor Network - May 4, 2018 Category: Universities & Medical Training Authors: pastafan Source Type: forums

Physician Assistant is better than Rph
I already posted that a PA makes more money in Southern Cal. But now I am looking at admissions. I looked at the Western University prospective students for both. The results are below. I can see why being a PA is better. Two years school vs 4. Your job is clinical and not pill pushing. PAs and nurses are taking over blood pressure, cholesterol, and diabetes clinics. Coumadin clinics have lost 70 percent of their volume due to direct thrombin inhibitors. Based on the data below, PA... Physician Assistant is better than Rph (Source: Student Doctor Network)
Source: Student Doctor Network - November 18, 2017 Category: Universities & Medical Training Authors: MrBonita Source Type: forums

Net clinical benefit of dabigatran vs. warfarin: Nothing. Zero.
(Source: BMJ Comments)
Source: BMJ Comments - November 15, 2017 Category: General Medicine Source Type: forums

switching from DOACs to warfarin
Hi, I was wondering when you switch from DOACs (like xarelto,eliquis) to warfarin, why do you have to bridge with LMWH? isn't keeping the patient on both for a few days until warfarin become therapeutic is enough? Or is it too dangerous to be on both, even for a few days? Please help me clarify. Many thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - November 3, 2017 Category: Universities & Medical Training Authors: qtern Source Type: forums

Re: Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study
(Source: BMJ Comments)
Source: BMJ Comments - October 19, 2017 Category: General Medicine Source Type: forums

MNBB with coumadin for A-fib
would you stop coumadin for 5 days on an elderly patient with A-fib for MNBB? According to 2015 ASRA guideline MNBB is considered intermediate risk procedure in general and high risk in someone on anticoags. coumadin needs to be stopped for 5 days with normalization of PT/INR. On the other hand, I'm not sure if it outweighs the risk of thromboembolism for someone with A-fib. (Source: Student Doctor Network)
Source: Student Doctor Network - July 30, 2017 Category: Universities & Medical Training Authors: drpainfree Source Type: forums

Important Drug Interaction in inpatient pharmacy
What are some important drug interaction in inpatient pharmacy setting? I've been taught and practiced unless it's super x drug interaction like anticoagulant (ie. warfarin+apixaban), I let it go since it's acute care setting. Also, any thoughtful interventions you guys made in inpatient setting to the doctors? (Source: Student Doctor Network)
Source: Student Doctor Network - June 28, 2017 Category: Universities & Medical Training Authors: skarndghks2017 Source Type: forums

Anyone here on Warfarin medication?
Forum: Advice on everyday issues Posted By: xdmccann Post Time: 25-06-2017 at 13:05 (Source: The Student Room)
Source: The Student Room - June 25, 2017 Category: Universities & Medical Training Source Type: forums

Looking to get out of clinical pharmacy and into retail
Hi everyone, I've been a clinical pharmacist for 2 years, got a job right out of pharmacy school at a small town community hospital and became one of the staff. I've done vancomycin/aminoglycoside dosing, warfarin monitoring, parenteral nutrition, etc. But I'm looking for a career change and wanting to move to a bigger city and do retail, eventually I want to open up my own independent pharmacy. I don't have much retail experience besides a short stint moonlighting at an independent retail... Looking to get out of clinical pharmacy and into retail (Source: Student Doctor Network)
Source: Student Doctor Network - April 25, 2017 Category: Universities & Medical Training Authors: rawlithium Source Type: forums

FFP vs (iv Vit K+prothombin complex concentrate)
was doing a Mksap question, where an elderly patient comes into the ER with a SDH and mass effect, very symptomatic, Afib+coumadin with an INR=12. Which of the following is the most appropriate treatment? my answer was FFP (and ~79% percent agreed). But the correct answer was iv Vit K+prothombin complex concentrate. Really? Isn't this a dire situation that requires immediate correction, wouldn't FFP provide that? (I understand that patient would likely need long term Vit K, you could... FFP vs (iv Vit K+prothombin complex concentrate) (Source: Student Doctor Network)
Source: Student Doctor Network - January 23, 2017 Category: Universities & Medical Training Authors: DrMetal Source Type: forums

epidural catheter removal and platelets.
I know...we have had this discussion before. Anyway. Clinical scenario - Patient with history x 2 of DVT (I think one was also a PE) and on Coumadin....bridged to lovenox for Knee replacement. Epidural placed with platelets 102. Day one - platelets, 64 at 4am. Surgeons are anxious to start Lovenox - therapeutic dosing. Recheck of platelets at noon - 70. Decision time. I'm sure there are lots of different ways to do this - but here where the options I thought I should decide on.... epidural catheter removal and platelets. (Source: Student Doctor Network)
Source: Student Doctor Network - December 16, 2016 Category: Universities & Medical Training Authors: epidural man Source Type: forums

Knee Injection on Coumadin AND Plavix
What are your thoughts on doing an intra articular knee injection on a patient on Coumadin and plavix concurrently. The patient's INR is on the low therapeutic range. I've found a lot of evidence that says its safe to do joint injections on coumadin, if the patient's INR is therapeutic, but couldn't find anything specifically about coumadin and plavix together. Any sources/references/practical advice would be appreciated. Thanks. (Source: Student Doctor Network)
Source: Student Doctor Network - September 24, 2016 Category: Universities & Medical Training Authors: theanswer03 Source Type: forums

Re: Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study
(Source: BMJ Comments)
Source: BMJ Comments - June 29, 2016 Category: Journals (General) Source Type: forums

Re: Association between use of warfarin with common sulfonylureas and serious hypoglycemic events: retrospective cohort analysis
(Source: BMJ Comments)
Source: BMJ Comments - June 27, 2016 Category: Journals (General) Source Type: forums

So my dad died
PGY-2 heading into my 3rd and final year. I am sitting in an airport with my flight delayed and I have had far too much time to think. I got called yesterday from my mother "call me as soon as you can, it's not urgent but please call me." I woke up from my night shift and called her back. She was crying and got out the simple words "your dad has died". My father wasn't the healthiest man and his chart would read; patient with a history of DM, HTN, HLD, PE (on coumadin), and MI admitted... So my dad died (Source: Student Doctor Network)
Source: Student Doctor Network - June 23, 2016 Category: Universities & Medical Training Authors: jshultz Source Type: forums

Polypharmacy in atrial fibrillation: apixaban versus warfarin
(Source: BMJ Comments)
Source: BMJ Comments - June 20, 2016 Category: Journals (General) Source Type: forums

Intraop Seizure
Long time lurker here. Enjoyed reading clinical discussions. I'm quite fresh out of training and would appreciate any feedback or wisdom about a recent case: 50 yo F for elective lumbar laminectomy. PMH of lupus anticoagulant with previous right central retinal vein thrombosis on plavix + coumadin, off both for 5 days for surgery. She's on Plaquenil, CellCept, Prednisone for SLE. No h/o HTN, DM, stroke, heart/lung/renal/hepatic issues. 100kg BMI 35. NKDA. No previous GA anesthetic... Intraop Seizure (Source: Student Doctor Network)
Source: Student Doctor Network - June 9, 2016 Category: Universities & Medical Training Authors: eggscal99 Source Type: forums

Mnemonic 4 Coumadin or Synthroid Colors!
Any one has a mnemonic for the colors of mnemonic Coumadin or Synthroid tablets? (Source: Student Doctor Network)
Source: Student Doctor Network - April 25, 2016 Category: Universities & Medical Training Authors: PharmD2008FL Source Type: forums

Should we trust INR testing?
  We read with interest the recent BMJ editorial “Rivaroxaban:Can we trust the evidence”.1 which questions the conclusions from the ROCKET AF clinical trial on Rivaroxaban 2. Cohen raises questions about the accuracy of the INRs used for monitoring patients in the warfarin control arm and suggests that they may have compromised the validity of the published conclusions. The ROCKET investigators have defended their conclusions after re assessing the data in light of these concerns 3. The device used for INR testing in the warfarin control arm was not identified in the original publication but subsequen...
Source: Doc2Doc BMJ Cardiology - April 7, 2016 Category: Cardiology Authors: alaminium Source Type: forums

NBME 17 discussion
Can you guys correct me on this ---------------------------------------------------------------------- 8.old woman with DVT. Platelet dropped significantly after a week of tx. Drug of action? a. activate tissue plasminogen -----action of tPA b. Interferes with carboxylation of coag factors ----action of warfarin c. irreversibly inactivate COX -----Aspirin d. Potentiates the action of antithrombin iii (correct answer, action of Heparin, and this is Heparin induced Thrombocytopenia... NBME 17 discussion (Source: Student Doctor Network)
Source: Student Doctor Network - March 26, 2016 Category: Universities & Medical Training Authors: fatwalletuab Source Type: forums

Re: High INR on warfarin
(Source: BMJ Comments)
Source: BMJ Comments - January 24, 2016 Category: Journals (General) Source Type: forums

Warfarin use might increase hip fracture risk in older diabetic adults treated with sulfonylureas
(Source: BMJ Comments)
Source: BMJ Comments - December 11, 2015 Category: Journals (General) Source Type: forums

Re: Real world effectiveness of warfarin among ischemic stroke patients with atrial fibrillation: observational analysis from Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study
(Source: BMJ Comments)
Source: BMJ Comments - October 15, 2015 Category: Journals (General) Source Type: forums

A Surgeons Dilemma. Real world effectiveness of warfarin among ischemic stroke patients with atrial fibrillation: observational analysis from Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study
(Source: BMJ Comments)
Source: BMJ Comments - August 12, 2015 Category: Journals (General) Source Type: forums

Bleeding Risk in Warfarin-Treated Patients with Kidney Disease
Studies have shown that warfarin-treated patients with substantially impaired renal function require lower warfarin doses   http://www.jwatch.org/na37937/2015/05/20/bleeding-risk-warfarin-treated-patients-with-kidney?query=etoc_jwcard (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 28, 2015 Category: Cardiology Authors: Mukhtar Ali Source Type: forums

Clinical question of the week: How would you treat this patient w palpitations, dyspnoea, dark stools?
A 75-year-old male with a prior history of hypertension, diabetes and treatment for “arrhythmia” presented to the emergency department complaining of palpitations and dyspnea on exertion over the last two days. The patient also reported dark stools over the last two days. No other symptoms were reported. Current medications included atenolol 50 mg qD, warfarin 5 mg qD, metformin 850 mg BiD.   The patient did not remember his last INR result, but reported no blood tests over the last two months. On examination the heart rate was 140, irregular, BP was 90/70, respiratory rate 22, SatO2: 94%. The patient ...
Source: Doc2Doc BMJ Cardiology - May 11, 2015 Category: Cardiology Authors: MBittencourt Source Type: forums

Clinical question of the week: "Arrhythmia" patient with palpitations, dyspnoea, and dark stools
A 75-year-old male with a prior history of hypertension, diabetes and treatment for “arrhythmia” presented to the emergency department complaining of palpitations and dyspnea on exertion over the last two days. The patient also reported dark stools over the last two days. No other symptoms were reported. Current medications included atenolol 50 mg qD, warfarin 5 mg qD, metformin 850 mg BiD.   The patient did not remember his last INR result, but reported no blood tests over the last two months. On examination the heart rate was 140, irregular, BP was 90/70, respiratory rate 22, SatO2: 94%. The patient ...
Source: Doc2Doc BMJ Cardiology - May 11, 2015 Category: Cardiology Authors: MBittencourt Source Type: forums

Re: High INR on warfarin
(Source: BMJ Comments)
Source: BMJ Comments - April 28, 2015 Category: Journals (General) Source Type: forums

Clinical question of the week: Do novel oral anticoagulants (NOAC) need monitoring just like warfarin?
In the management of long term conditions, drug adherence and compliance remains an important problem. The cardiology community has responded positively to the introduction of novel oral anticoagulants (NOAC) as, in contrast to warfarin, NOAC obviates the need for regular monitoring. Is this too good to be true? A study published in JAMA this week concluded that, among nonvalvular atrial fibrillation patients treated with NOAC, there is wide variability in patient medication adherence. Moreover, there is data to suggest that lower adherence with NOAC is associated with poorer outcomes and that warfarin style monitoring m...
Source: Doc2Doc BMJ Cardiology - April 20, 2015 Category: Cardiology Authors: Heart Matters Source Type: forums

Re: High INR on warfarin
(Source: BMJ Comments)
Source: BMJ Comments - April 19, 2015 Category: Journals (General) Source Type: forums

What is the future of "Triple Therapy" after coronary stenting?
Identifying the optimal regimen for antiplatelet therapy in patients requiring long-term anticoagulation following coronary stenting is an area that has traditionally been understudied. Although all major guidelines recommend (limited) triple therapy  in this situation, these recommendations are either result of expert consensus or are largely based on observational data. The WOEST trial was an open-labelled randomised trial and compared dual therapy (a combination of clopidogrel and vitamin K antagonist) with  triple therapy (Aspirin, clopidogrel and vitamin K antagonist) in patients undergoing coronary stent...
Source: Doc2Doc BMJ Cardiology - November 17, 2014 Category: Cardiology Authors: Heart Matters Source Type: forums

NICE draft guidelines for AF
The NICE guidelines for AF are now in draft form and recommend systematic use of a thromboembolic risk and bleeding score (as per the BMJ cardiovascular team of the year 2013!) and also suggest that the novel oral anticoagulants be considered first line together with warfarin. The first seems sensible and timely but what about the second? sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - January 25, 2014 Category: Cardiology Authors: sadian Source Type: forums

is warfarin heading for a comeback?
I was looking at the re-align study of anticoagulation in mechanical valves that compared warfarin with dabigatran. In this group dabigatran was associated with more bleeding and thrombosis complications. Is warfarin heading for a comeback? http://www.nejm.org/doi/full/10.1056/NEJMoa1300615 sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - November 14, 2013 Category: Cardiology Authors: sadian Source Type: forums

What would you like to ask the BMJ Cardiovascular Team of the Year?
For the new doc2doc BMJ Guide to Cardiology, we are interviewing the BMJ Cardiovascular Team of The Year. What questions would you like me to ask them? Please submit your questions below...    Cardiovascular Team of the Year  The Birmingham Atrial Fibrillation Team University of Birmingham Centre for Cardiovascular Sciences and Sandwell and West Birmingham Hospitals NHS Trust, West Midlands The team developed a new bleeding risk score specifically for use in Atrial Fibrillation.  HAS-BLED provides clinicians with a validated tool to assess bleeding risk, allowing them to identify modifiable ble...
Source: Doc2Doc BMJ Cardiology - October 18, 2013 Category: Cardiology Authors: Matthew Billingsley Source Type: forums

Recurrence of DVT while on newer anticoagulant therapy ( Rivoroxaban 20mg once daily).
Pt did not tolerate warfarin due to very Labile INR with smallest changes in the dose.  Indication :Right MCA infarct with AF with Recurrent DVT's and PE. Pt has recurrence of DVT while being on Rivoroxaban for 6 wks. Any comments regarding change in management? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - October 15, 2013 Category: Cardiology Authors: ajaygupta480 Source Type: forums

FDA Investigation Finds No Excess Bleeding Risk for Dabigatran
In its latest assessment of a highly controversial issue, the FDA has found no indication that bleeding rates for dabigatran (Pradaxa, Boehringer-Ingelheim) are any higher than the bleeding rates for warfarin. The FDA investigation was in response to the large number of post-marketing reports of bleeding in people taking dabigatran. Click here to for the full FDA statement. Here is the first paragraph of the statement: The U.S. Food and Drug Administration (FDA) has evaluated new information about the risk of serious bleeding associated with use of the anticoagulants (blood thinners) dabigatran (Pradaxa) and warf...
Source: CardiologyNetwork.com - October 13, 2013 Category: Cardiology Authors: Indian Diabetics Foundation Team Source Type: forums

Rivaroxaban Gains FDA Indications for Treating and Preventing DVT and PE
The FDA has expanded the indication for rivaroxaban (Xarelto, Johnson & Johnson) to include the treatment of deep-vein thrombosis (DVT) and pulmonary embolism (PE) and to reduce the risk for recurrent DVT and PE. The oral anticoagulant is already approved to reduce postsurgical risk for DVT and PE  after hip- and knee-replacement surgery and to reduce the risk for stroke in people with atrial fibrillation. The new indication was granted under the FDA’s priority review program. “Xarelto is the first oral anti-clotting drug approved to treat and reduce the recurrence of blood clots since the approval of ...
Source: CardiologyNetwork.com - October 13, 2013 Category: Cardiology Authors: Indian Diabetics Foundation Team Source Type: forums

What's the best antiplatelet regime for patients on wafarin?
I often struggle with this for patients in AF who end up having a stent and often find that aspirin plus clopdiogrel plus warfarin can be a very difficult combination particularly when a drug eluting stent has been implanted! I'm pleased to see a trial that supports what I think many cardiologists do in practice which is warfarin and clopidogrel only (plus a PPI!)http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)62177-1/abstractWhat's your antiplatelet regime of choice in this situation?sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - February 23, 2013 Category: Cardiology Authors: sadian Source Type: forums

Upper Extremity DVT with subclavians/piccs
I placed a subclavian in a patient with pylephlebitis, put the dude on hepatin and coumadin. All is well. A week later he complains of UE pain and swelling in ipsilateral arm (pt refused IJ). Got U/S and kablamo: clot running from basilic through subclavian. We pulled the line slllooowwwwllllyyyy (he needed placement with long term iv abx so he eventually got an IJ tunnelled picc). we had to heparinize the guy for his portal/superior mesenteric vein clot. How often do you guys see them? How often do you you sweat pulling the line? should you pull the line if its around a picc in a pt who needs long term IV access? If th...
Source: Student Doctor Network Forums - January 30, 2013 Category: Universities & Medical Training Authors: VentdependenT Tags: Critical Care Source Type: forums

ivc filters for thromboembolic disease
my colleague and i spent about 30mins debating this case yesterday70 year old manpreviously fit and healthydvt and pe post flight to us last may6 months warfarin very breathless - echo mild rv dilatation, right heart cath 3 months in normal pa pressureswarfarin stopped at 6 months and then further dvt and pe 8 days later - now on lifelong warfarinhad episode about 6 weeks ago with further leg swelling and chest pain for 1 day, didn't seek medical advice and no inr recordedwould you recommend an ivc filter in his case? We both had different ideas so I'm keen to hear what others think?sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - January 25, 2013 Category: Cardiology Authors: sadian Source Type: forums