Non-vitamin K antagonist oral anticoagulants (NOACs) and valvular heart disease with AF
Subgroup analysis of certain clinical trials support the use of rivaroxaban, apixaban, dabigatran and edoxaban in patients with aortic stenosis, aortic regurgitation or mitral regurgitation having atrial fibrillation. NOACs can also be used in aortic bioprosthesis with atrial fibrillation if the valve has been implanted more than 3 months back.
NOACs are better avoided in those with moderate or severe mitral stenosis and atrial fibrillation in view of high thromboembolic risk. NOACs should not be used in those with mechanical prosthetic valve with or without atrial fibrillation. Those patients still require vitamin K anta...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is PT-INR monitoring? Cardiology Basics
INR is short for International Normalized Ratio of Prothrombin Time. It is also called PT-INR. The INR monitoring is used to monitor the dosage of vitamin K antagonists like warfarin. Vitamin K antagonists are used for stroke prevention in atrial fibrillation as well as for deep vein thrombosis and pulmonary embolism. Non vitamin K oral anticoagulants (NOACs), also known as direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban and apixaban do not need INR monitoring. Warfarin is routinely used when there is a mechanical prosthetic valve, to prevent valve thrombosis and thromboembolism. As of now, DOACs are not i...
Source: Cardiophile MD - October 25, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
How is pulmonary embolism treated? Cardiology Basics
Pulmonary embolism is obstruction of pulmonary arteries due to emboli migrating from other parts of the body. It is a potentially life threatening condition if a major branch or multiple branches are obstructed. More emboli can travel to the lungs from the original source and hence pulmonary embolism may worsen later even if the initial episode involves only a small portion of the lungs. So, it is important to treat pulmonary embolism even if it is mild. Treatment options will depend on the severity of the situation.
Initial treatment will be with parenteral anticoagulants like heparin or low molecular weight heparin. Aft...
Source: Cardiophile MD - October 18, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiology MCQs
Surgical correction for congenitally corrected transposition of great arteries is:
Jatene operation
Mustard operation
Senning operation
Double switch operation
Correct answer: 4. Double switch operation
Definitive surgical correction of c-TGA is known as double switch. Atrial switch is by a modified Senning procedure for rerouting the pulmonary and systemic venous return. Arterial switch is done for correction of ventriculoarterial discordance [Sharma R, Bhan A, Juneja R, Kothari SS, Saxena A, Venugopal P. Double switch for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg. 1999 Mar;15(...
Source: Cardiophile MD - July 3, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Idarucizumab for reversal of direct thrombin inhibitor dabigatran
Idarucizumab is a monoclonal antibody fragment used to reverse the anticoagulant effect of direct thrombin inhibitor dabigatran. RE-VERSE AD (Reversal of Dabigatran Anticoagulant Effect With Idarucizumab) clinical trial evaluated the safety and efficacy of 5 g idarucizumab given intravenously [1]. An article on interim analysis of 90 patients was published first. In that report, 51 patients in group A of the study had serious bleeding while 39 patients in group B required an urgent procedure. Primary end point of the study was the maximum percentage reversal of the anticoagulant effect of dabigatran within four hours of a...
Source: Cardiophile MD - June 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Prodrug among DOAC/NOACs – Cardiology MCQ – Answer
Prodrug among DOAC/NOACs – Cardiology MCQ – Answer
Which of the following DOAC/NOAC is a prodrug? – Correct answer: a) Dabigatran
Only dabigatran etexilate is a prodrug among the DOAC/NOACs. It is transformed to active form by esterases which are ubiquitous [1].
Back to question
Reference
Qamar A, Vaduganathan M, Greenberger NJ, Giugliano RP. Oral Anticoagulation in Patients With Liver Disease. J Am Coll Cardiol. 2018 May 15;71(19):2162-2175.
The post Prodrug among DOAC/NOACs – Cardiology MCQ – Answer appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - April 29, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Prodrug among DOAC/NOACs – Cardiology MCQ
Prodrug among DOAC/NOACs – Cardiology MCQ
Which of the following DOAC/NOAC is a prodrug?
a) Dabigatran
b) Apixaban
c) Rivaroxaban
d) Edoxaban
Post your answer as a comment below
The post Prodrug among DOAC/NOACs – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - April 29, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
DOAC in renal impairment – Cardiology MCQ
DOAC in renal impairment – Cardiology MCQ
Which of the following direct oral anticoagulants (DOACs) is most suitable in a patient with atrial fibrillation and renal dysfunction:
a) Dabigatran
b) Apixaban
c) Rivaroxaban
d) Betrixaban
Please post your answer as a comment below
The post DOAC in renal impairment – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - April 17, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Direct oral anticoagulant (DOAC) – Cardiology MCQ
Direct oral anticoagulant (DOAC) – Cardiology MCQ
Which of the following is not an indication for direct oral anticoagulant (DOAC) like dabigatran:
a) Prophylaxis against stroke in AF
b) Prophylaxis against systemic embolism in nonvalvular atrial fibrillation AF
c) Treatment and prevention of recurrent venous thromboembolism
d) Mechanical prosthetic mitral valve
Post your answer as a comment below
The post Direct oral anticoagulant (DOAC) – Cardiology MCQ appeared first on All About Cardiovascular System and Disorders. (Source: Cardiophile MD)
Source: Cardiophile MD - April 17, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Embolic stroke of undetermined source (ESUS)
Cryptogenic Stroke/ESUS International Working Group defined embolic stroke of undetermined source (ESUS) as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation [1]. They presumed that as emboli are more likely to be thrombi, recurrence may be better prevented by anticoagulation rather than antiplatelet agents. Randomized trials with directly acting oral anticoagulants were suggested to test this hypothesis.
But two randomised trials testing this aspect, NAVIGATE ESUS (Rivaroxaban Versus Aspirin in Secondary Prevention of Stroke and Prevention...
Source: Cardiophile MD - February 21, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
DOACs now recommended over warfarin to prevent blood clots in people with atrial fibrillation
For decades, warfarin (Coumadin) was the standard anticoagulant medication used to prevent blood clots, which can lead to stroke, in people with atrial fibrillation (afib). Direct oral anticoagulants (DOACs), sometimes called novel oral anticoagulants (NOACs), are a new type of anticoagulant medication that came on the market in 2010.
In 2019, the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) updated their afib guidelines to strongly recommend using DOACs over warfarin in people with afib.
Warfarin is effective, but has downsides
Afib is a condition in which the upper chambers...
Source: Harvard Health Blog - December 16, 2019 Category: Consumer Health News Authors: Peter Zimetbaum, MD Tags: Drugs and Supplements Heart Health Source Type: blogs
Cardiology MCQ – Anticoagulation in pregnancy – Answer
Cardiology MCQ – Anticoagulation in pregnancy – Answer
My Cardiology MCQ books on Amazon
Best maternal outcomes in mechanical prosthetic valves with pregnancy is obtained with:
Correct answer: 3. Warfarin
Best maternal outcome in pregnancy with mechanical prosthetic valves is obtained with warfarin [1]. But it is a known teratogen and is associated with lowest number of live births. Low molecular weight heparin probably gives the best fetal outcome, though the maternal risk of thromboembolism is higher. Dabigatran is not recommended for mechanical prosthetic valves even without pregnancy.
Generally warfarin is...
Source: Cardiophile MD - December 8, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Cardiology MCQ – Anticoagulation in pregnancy
Cardiology MCQ – Anticoagulation in pregnancy
Best maternal outcomes in mechanical prosthetic valves with pregnancy is obtained with:
Low molecular weight heparin
Heparin
Warfarin
Dabigatran
Click here for the answer with discussion (Source: Cardiophile MD)
Source: Cardiophile MD - December 8, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Over-the-counter cold and flu medicines can affect your heart
As the cold and flu season continues this year, it is important to be aware that many of the most commonly used over-the-counter (OTC) remedies for congestion, aches, pains, and low-grade fevers contain medicines that can have harmful effects on the cardiovascular system. Chief among these medications are nonsteroidal anti-inflammatory drugs (NSAIDs) and decongestants.
NSAIDs and your heart
Certain NSAIDs are associated with a small increase in the relative risk for developing a heart attack, stroke, heart failure, atrial fibrillation, increased blood pressure, and blood clots. NSAIDs relieve pain and inflammation by inhib...
Source: Harvard Health Blog - March 20, 2019 Category: Consumer Health News Authors: Mark Benson, MD, PhD Tags: Cold and Flu Drugs and Supplements Health Heart Health Source Type: blogs
How dangerous are NSAIDs in patients with AF?
One of the most commonly asked questions in the office is the treatment of arthritis pain. This comes up because of the concern over taking NSAIDs (non steroidal anti-inflammatory drugs) in patients who are on anticoagulants (such as warfarin, or dabigatran, rivaroxaban, apixaban).
My views on this matter have changed.
But first, I want to mention a study published in JACC that addressed the issue of NSAID use in pts with AF who take an anticoagulant.
This was a sub-analysis of the RELY trial, which pitted dabigatran vs warfarin. Remember, in the original RELY trial, the 150mg dose of dabigatran did better than warfarin at...
Source: Dr John M - July 13, 2018 Category: Cardiology Authors: Dr John Source Type: blogs
