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Total 134 results found since Jan 2013.

Novel Oral Anticoagulants
Abstract: Warfarin has a proven record as an oral anticoagulant; almost every study, however, has found that it is not prescribed for 40–60% of patients who are eligible and should receive it, and of those who do receive it, serum warfarin levels only achieved a time in therapeutic range (TTR) equal to INR 2–3 about 55–60% of the time (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). This means that only about 1 in 4 patients are adequately anticoagulated with warfarin, and thus there is a large unmet need for achieving better anticoagulation in these patients. Although...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: James A. Reiffel Tags: CME multimedia activities Source Type: research

Perioperative selective serotonin reuptake inhibitor administration is a marker of poor outcomes after surgery
Commentary on: Auerbach AD, Vittinghoff E, Maselli J, et al.. Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery. JAMA Intern Med 2013;173:1075–81. Context With a lifetime prevalence of 6–11%, depression is a common comorbidity in surgical patients. Owing to their high efficacy and safety, selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants.1 Some studies suggest that SSRIs may increase surgical bleeding. However, SSRI discontinuation may exacerbate psychiatric illness or precipitate withdrawal symptoms. Therefore, ...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Holt, N. F. Tags: EBM Aetiology, Epidemiologic studies, Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Heart failure, Stroke, Obesity (nutrition), Interventional cardiology, Drugs: musculoskeletal and joint diseases, Health education Source Type: research

Use of antithrombotics in atrial fibrillation in Africa, Europe, Asia and South America: Insights from the International RealiseAF Survey.
CONCLUSION: There is substantial deviation from international guidelines in antithrombotic use for AF in routine clinical practice, with overuse and underuse of antithrombotics in about 50% of the cases and important geographical differences. These findings emphasize the need for improved medical education worldwide and a better understanding of geographical disparities in the implementation of guidelines. PMID: 24556189 [PubMed - as supplied by publisher]
Source: Archives of Cardiovascular Diseases - February 17, 2014 Category: Cardiology Authors: Gamra H, Murin J, Chiang CE, Naditch-Brûlé L, Brette S, Steg PG, RealiseAF investigators Tags: Arch Cardiovasc Dis Source Type: research

Early Adoption of Dabigatran and Its Dosing in US Patients With Atrial Fibrillation: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Health Services and Outcomes Research
Conclusions Patients receiving dabigatran were younger and at a lower risk of stroke and bleeding. Patients appeared to drive switching from warfarin, whereas clinical characteristics influenced de novo start of dabigatran. These data suggest cautious early uptake of dabigatran, and more careful attention to dosing adjustments is warranted. Clinical Trial Registration URL: Clinicaltrials.gov. Unique identifier: NCT01165710.
Source: JAHA:Journal of the American Heart Association - November 25, 2013 Category: Cardiology Authors: Steinberg, B. A., Holmes, D. N., Piccini, J. P., Ansell, J., Chang, P., Fonarow, G. C., Gersh, B., Mahaffey, K. W., Kowey, P. R., Ezekowitz, M. D., Singer, D. E., Thomas, L., Peterson, E. D., Hylek, E. M., The Outcomes Registry for Better Informed Treatme Tags: Health Services and Outcomes Research Source Type: research

Use of novel oral anticoagulants for patients with atrial fibrillation: Systematic review and clinical implications
Abstract: Atrial fibrillation (AF), a common arrhythmia, increases the risk of ischemic stroke. Stroke and bleeding scores for patients with AF can help to stratify risk and determine the need for antithrombotic therapy, for which warfarin has been the gold standard. Although highly effective, warfarin has several limitations that can lead to its underuse. Data from randomized, Phase III clinical trials of the novel oral anticoagulants, dabigatran, a direct thrombin inhibitor, and rivaroxaban and apixaban, both factor Xa inhibitors, indicate these drugs are at least noninferior to warfarin for the prevention of stroke and ...
Source: Heart and Lung - November 13, 2013 Category: Intensive Care Authors: Nancy M. Albert Tags: Care of Patients with Dysrhythmias Source Type: research

Applying Antithrombotic Therapies to Improve Outcomes in Patients With Atrial Fibrillation
Abstract: Approximately 15% to 25% or 75,000 ischemic strokes are attributed to atrial fibrillation annually within the United States. Atrial fibrillation is the most frequently diagnosed cardiac arrhythmia and affects more than 2.66 million Americans. Moreover, atrial fibrillation is associated with a 1.5 to 1.9-fold higher risk of death due to its strong correlation with thromboembolic events. Because of the attributed increased morbidity and mortality, challenges that concern identification of patients at risk for thromboembolic events from atrial fibrillation must be addressed. These challenges include compliance to pe...
Source: The American Journal of Cardiology - August 1, 2013 Category: Cardiology Authors: Chris Cannon, Michael D. Ezekowitz, Christopher Granger Tags: Multimedia Activities Source Type: research

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting
Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with an...
Source: Anesthesiology - April 23, 2013 Category: Anesthesiology Tags: Education: Review Article Source Type: research

Factors that influence awareness and treatment of atrial fibrillation in older adults
Conclusions: With projected doubling of numbers of persons over 80 in the next 30 years in the British Isles, detection and management of AF is pressing. Two-thirds of adults at high risk of stroke were inadequately treated. More regular screening for AF, application of criteria for stroke and bleeding risk and awareness of factors influencing diagnosis and treatment is recommended.
Source: QJM - April 21, 2013 Category: Internal Medicine Authors: Frewen, J., Finucane, C., Cronin, H., Rice, C., Kearney, P. M., Harbison, J., Kenny, R. A. Tags: Original papers Source Type: research

Chronic abdominal pain in children: help in spotting the organic diagnosis
Case 1 Aisha, a 9-year-old Asian girl, was referred to the paediatric outpatient clinic by her general practitioner (GP) with a 4 month history of episodic central abdominal pain. Each episode would last a few hours, affecting her about three times per week, usually during the day, but also occasionally at night. This was associated with infrequent, non-bilious vomits but did not appear to be related to diet. She was missing some days of school because of her symptoms. She said she liked school, did not like missing days away from her friends and denied any bullying. Between episodes she was a well and active girl. Sh...
Source: Archives of Disease in Childhood - Education and Practice - January 16, 2013 Category: Pediatrics Authors: Wright, N. J., Hammond, P. J., Curry, J. I. Tags: GI bleeding, Constipation, Diarrhoea, Editor's choice, Headache (including migraine), Pain (neurology), Stroke, Childhood nutrition, Diet, Child and adolescent psychiatry (paedatrics), Childhood nutrition (paediatrics), Child health, Neonatal health, Radi Source Type: research

Gene breakthrough boosts hope of drug for blood diseases
Discovery could prevent lethal blood clots and help children with rare platelet function disorderNoah Edwards is four years old and suffers from a disorder that prevents his blood from clotting. He bleeds profusely when cut and his face and body are easily bruised.His condition, called platelet function disorder, is a constant worry for his mother, Ruby. However, thanks to Noah's involvement in a remarkable project, funded by the British Heart Foundation, his prospects of leading a normal life have received a major boost.Researchers at Birmingham University have uncovered the genetic roots of platelet function disorder, a ...
Source: Guardian Unlimited Science - January 13, 2013 Category: Science Authors: Robin McKie Tags: University of Birmingham Genetics Biology News Medical research Higher education UK news The Observer Science Source Type: news

Summary: International Kidney Cancer Symposium
Conclusions:  Ideal ischemia time is 20-25 minutes or less improves short and long term renal function.  >25 minutes carried 5 year risk of new onset stage 4 CKD No differences on GFR for cold vs. warm ischemia times Preoperative GFR and the percent of kidney preserved was a better predictor of post op GFR.  No ischemia preserves renal function better than warm. Longer cold ischemia times were equivalent to shorter warm ischemia times. Quality and quantity of the remaining kidney is associated with ultimate renal function. Robotics in RCC Surgery Gennady Bratslavsky, MD The...
Source: Kidney Cancer Association - December 15, 2011 Category: Urology & Nephrology Source Type: news