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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

Mr. M
Dr. Migliore I step off the subway, up the elevator, and up several flights of stairs. There’s a homeless man there who always uses the last stair of the lower staircase as a tray for his food. And by tray, I mean he sets his half-eaten rice burrito directly onto the step and picks around at it while I imagine the guacamole is mixing with Hep B and C. diff and MRSA. He looks up at me, I promise myself for the 100th time I’m going to start carrying cash or Kind bars or something; I give him my best sheepish face, and emerge at street level. I walk toward my hospital and pass a gentleman who sits on a ledge next to the ...
Source: The Hospitalist - December 1, 2022 Category: Hospital Management Authors: Lisa Casinger Tags: Essay Source Type: research