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The Price of Keeping the Rhythm: Increased Bleeding Risk in Patients with Atrial Fibrillation Concurrently Prescribed Amiodarone and Factor Xa Inhibitors
Atrial fibrillation is the most common sustained cardiac arrhythmia affecting nearly 2% of the population of the United States.1 Patients with atrial fibrillation are twice as likely to have a myocardial infarction and five-times as likely to have a stroke.1 Current guidelines recommend antiarrhythmic pharmacotherapy in patients with symptomatic atrial fibrillation as first-line management.2-4 Amiodarone is a very effective, and therefore, a commonly prescribed agent for this purpose.5 Anticoagulation is a key tenet in the management of atrial fibrillation due to the increased tendency of left atrial appendage clot formati...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 10, 2023 Category: Anesthesiology Authors: Nicolas Kumar, Manoj H. Iyer, Adam Dalia, Amit Bardia Tags: Editorial Source Type: research

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research