NOAC – Cardiology MCQ – Answer
In which of the following conditions non-vitamin K antagonist oral anticoagulants (NOACs) should not be used:
Correct answer: c) Mechanical prosthetic valve with atrial fibrillation
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 patients having atrial fibrillation. NOACs can also be used in aortic bioprosthesis with atrial fibrillation if the valve was implanted more than 3 months back.
NOACs are better avoided in those with moderate or severe mitral stenosis and atrial fibrillation...
Source: Cardiophile MD - June 13, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Fighting Hubris in Medicine
By ANISH KOKA
The weekend started with a tweet about an elderly man with atrial fibrillation. Atrial fibrillation is an arrhythmia of the heart that predisposes those who suffer with it to strokes. The strokes are a result of clots being thrown from the heart into the brain. The typical treatment for this condition in those deemed high enough risk is to thin the blood to help prevent these clots from forming, and thus reducing the risk of stroke.
101 year old with a history of a stroke stops his Pradaxa. Only other history hypertension. https://t.co/Ai5z519rcX
— Anish Koka (@anish_koka) June 3, 2018
The pro...
Source: The Health Care Blog - June 7, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
A Tale of 2 FDAs
By ANISH KOKA
Frances Oldham Kelsey by all accounts was not mean to have a consequential life. She was born in Canada in 1914, at a time women were meant to be seen and not heard. Nonetheless, an affinity for science eventually lead to a masters in pharmacology from the prestigious McGill University. Her first real break came after she was accepted for PhD level work in the pharmacology lab of a professor at the University of Chicago. An esteemed professor was starting a pharmacology lab and needed assistants, and the man from Canada seemed to have a perfect resume to fit. That’s right, I said man. France...
Source: The Health Care Blog - June 4, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
LITFL Review 326
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 326th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
Readers can subscribe to LITFL review RSS or LITFL review EMAIL subscription
The Most Fair Dinkum Ripper Beauts of the Week
Read this speci...
Source: Life in the Fast Lane - April 8, 2018 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs
MKSAP: 26-year-old woman with a mechanical mitral valve prosthesis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 26-year-old woman with a mechanical mitral valve prosthesis visits to discuss anticoagulation management during pregnancy. Her last menstrual period was 6 weeks ago and her pregnancy was confirmed by laboratory testing in the office. Her mitral valve was replaced 5 years ago. Her medications are low-dose aspirin, metoprolol, and warfarin (4 mg/d).
On physical examination, vital signs are normal. Cardiac auscultation demonstrates a normal mechanical S1. There are no murmurs or added sounds. Her INR is 2.6.
Whic...
Source: Kevin, M.D. - Medical Weblog - February 24, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology OB/GYN Source Type: blogs
Taking an anticlotting drug? If you need a procedure, be prepared
Millions of people with cardiovascular disease take drugs that help prevent blood clots, which can lodge in a vessel and choke off the blood supply to part of a leg, lung, or the brain. These potentially lifesaving medications include warfarin (Coumadin) and a class of drugs called non-vitamin K antagonist oral anticoagulants or NOACs. Examples include dabigatran (Pradaxa) and rivaroxaban (Xarelto).
However, if you’re taking one of these drugs and need an invasive procedure — anything from a tooth extraction to a hip replacement — managing the risks can be tricky, says cardiologist Dr. Gregory Piazza, assistant profe...
Source: Harvard Health Blog - November 1, 2017 Category: Consumer Health News Authors: Julie Corliss Tags: Drugs and Supplements Health Heart Health Surgery anticlotting drug anticlotting drugs Source Type: blogs
Cardiology MCQ Test 5
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Source: Cardiophile MD - October 22, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
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
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
New Policy on Comments
I am changing my policy on comments.
In the past, if you had one approved comment then all of your subsequent comments would post without moderation. I changed that.
Now I will moderate all comments. That means there may be a delay.
Another change is that I am not going to allow personal medical anecdotes. The reason is that heart rhythm diseases, especially atrial fibrillation, affect people in diverse ways. I counsel patients never to compare their problem with their friends’ problem. Therapy for AF has to be tailored to the individual. What’s right for you could be completely wrong for your buddy.
I will als...
Source: Dr John M - May 3, 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
