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https://www.readbyqxmd.com/read/28099375/routine-neurosurgical-consultation-is-not-necessary-in-mild-blunt-traumatic-brain-injury
#1
Paul R Lewis, Casey E Dunne, James D Wallace, Jason B Brill, Richard Y Calvo, Jayraan Badiee, Michael J Sise, Vishal Bansal, C Beth Sise, Steven R Shackford
BACKGROUND: The Brain Trauma Foundation guidelines provide indications for neurosurgical intervention in traumatic brain injury (TBI) with moderate or severe intracranial hemorrhage (ICH). In TBI patients with less severe ICH, the utility of neurosurgical consultation remains unclear. We sought to determine if routine neurosurgical consultation is necessary for mild blunt TBI patients with ICH. METHODS: A retrospective cohort study was conducted on 500 consecutive blunt TBI patients aged 15 years or older with Glasgow Coma Scale score ≥13 and ICH on initial head computed tomography (CT) admitted to a Level 1 trauma center over 28 months...
January 17, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28089498/anticoagulants-in-ischemia-guided-management-of-non-st-elevation-acute-coronary-syndromes
#2
REVIEW
Martin Mayer
BACKGROUND: The most recent joint guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) on the management of non-ST-elevation acute coronary syndromes (NSTE-ACS) are a result of a substantial and considered undertaking, and those involved deserve much recognition for their efforts. However, the handling of anticoagulants seems somewhat inadequate, and this is a highly-relevant matter when managing NSTE-ACS. OBJECTIVE OF THE REVIEW: Among areas of potential uncertainty, emergency medicine professionals might still be left wondering about the particulars of anticoagulant therapy when pursuing ischemia-guided management of NSTE-ACS (that is, managing NSTE-ACS without an intent for early invasive measures, such as coronary angiography and revascularization)...
January 3, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28087311/-the-role-of-novel-oral-anticoagulants-in-patients-undergoing-cryoballoon-ablation-for-atrial-fibrillation
#3
Giannis Baltogiannis, Gian-Battista Chierchia, Giulio Conte, Juan Sieira, Giacomo Di Giovanni, Giuseppe Ciconte, Carlo de Asmundis, Yukio Saitoh, Kristel Wauters, Ghazala Irfan, Pedro Brugada
AIM: Peri-procedural thromboembolic (TE) and hemorrhagic events are complications of major concern for patients undergoing cryoballoon (CB) ablation for atrial fibrillation (AF). While peri-procedural anticoagulation management could decrease the incidence of these complications, data on CB ablation are scarce. The role of novel oral anticoagulants (NOACs) has not been thoroughly tested in this population. METHODS: In the present study, we sought to assess acute peri-procedural complications in patients undergoing CB ablation for AF under different anticoagulation regimens; anticoagulation administration was performed according to the CHA2DS2-VASc score guidelines...
November 16, 2016: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/28086887/patients-and-physicians-perceptions-and-attitudes-about-oral-anticoagulation-and-atrial-fibrillation-a-qualitative-systematic-review
#4
Gemma Mas Dalmau, Elisenda Sant Arderiu, María Belén Enfedaque Montes, Ivan Solà, Sandra Pequeño Saco, Pablo Alonso Coello
BACKGROUND: Oral anticoagulant therapy reduces the risk of stroke in patients with atrial fibrillation, but many patients are still not prescribed this therapy. The causes of underuse of vitamin K antagonists oral anticoagulants are not clear but could be related, in part, to patients' and physicians' perceptions and attitudes towards the benefits and downsides of this treatment. The purpose of this systematic review was to evaluate and synthesize patients' and physicians' perceptions and attitudes towards the benefits and downsides of vitamin K antagonist, in order to explore potential factors related with its underuse...
January 13, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28079666/intravenous-tissue-plasminogen-activator-administration-for-ischemic-stroke-1-hour-after-epidural-catheter-removal-a-case-report
#5
Anne M Baciewicz, Calvin Lee, Alon Ben-Ari, Hojoong Kim, Alex T Lee
Anticoagulation after a recent neuraxial procedure poses risk for development of spinal hematoma. Clinical evidence supports prompt IV tissue plasminogen activator administration after onset of ischemic stroke. There is an absence of data regarding emergency fibrinolytic therapy for patients experiencing a stroke with recent neuraxial procedures, resulting in highly disparate, nonevidence-based guidelines. This report describes a patient who developed ischemic stroke when receiving postoperative epidural analgesia...
January 11, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28076631/targeting-stroke-risk-and-improving-outcomes-in-patients-with-atrial-fibrillation-in-latin-america
#6
Bruce Stambler, Fernando Scazzuso
CONTEXT AND OBJECTIVE: To examine stroke risk factors, including atrial fibrillation, management and prevention, and stroke outcomes across Latin America. DESIGN AND SETTING: Narrative review conducted at Piedmont Heart Institute, United States. METHODS: The PubMed, Embase and Cochrane databases were searched for stroke AND "Latin America" AND epidemiology (between January 2009 and March 2015). Further studies in the SciELO, World Health Organization and Pan-American Health Organization databases were used to address specific points...
November 2016: São Paulo Medical Journal, Revista Paulista de Medicina
https://www.readbyqxmd.com/read/28074295/-neuraxial-anaesthesia-and-noacs
#7
T Standl
BACKGROUND: Cardiovascular comorbidities in surgical patients are frequent and have a substantial impact on the postoperative outcome. Neuraxial blockades are able to reduce perioperative morbidity and mortality. The increasing use of new oral anticoagulants (NOAC) requires a high level of attention, especially in patients undergoing neuraxial blockades or requiring postoperative analgesia. OBJECTIVE: The goal of this article is to present the benefit of neuraxial anaesthesia and analgesia in patients with cardiovascular risks and perioperative management of NOAC in this setting...
January 10, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28066970/implementation-of-a-pharmacist-led-patient-controlled-analgesia-dosing-service
#8
Alen L Dezia, Tim D Baccus, Allycia M Natavio, Sean M Conroy, Levi M Hall
PURPOSE: The development and implementation of a pharmacist-led patient controlled analgesia (PCA) dosing service in a large academic institution is described. SUMMARY: To improve pain management at our institution and expand pharmacy clinical services, a pharmacist-led PCA dosing service was developed and implemented. The service is modeled after established antimicrobial and anticoagulation dosing services at our institution. A core group of pharmacists (service leaders) and a pain physician champion developed a policy and guideline and designed electronic medical record (EMR) tools to support the service...
January 9, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28058458/-vitamin-k-antagonists-is-their-prescription-really-medical-malpractice-%C3%A2-today
#9
E Rafflenbeul, J Müller-Ehmsen
Atrial fibrillation and venous thromboembolisms are frequent cardiovascular diseases. Until a few years ago only vitamin K antagonists (VKA) were available for oral anticoagulation as primary and secondary prevention of thrombembolic events. Currently, the non-vitamin K dependent new oral anticoagulants (NOAC) dabigatran, rivaroxaban, apixaban and edoxaban are approved for use. The approval studies, meta-analyses and data from registries provide evidence for the superiority of NOAC vs. VKA with respect to reduction of thrombembolisms and reduced bleeding complications; therefore, in the 2016 European Society of Cardiology (ESC) guidelines the use of NOAC is recommended as first line therapy for anticoagulation in atrial fibrillation (recommendation grade I/evidence level A)...
January 2017: Der Internist
https://www.readbyqxmd.com/read/28057775/catheter-ablation-for-atrial-flutter-a-survey-by-the-european-heart-rhythm-association-and-canadian-heart-rhythm-society
#10
Benedict M Glover, Jian Chen, Kathryn L Hong, Serge Boveda, Adrian Baranchuk, Kristina H Haugaa, Paul Dorian, Tatjana S Potpara, Eugene Crystal, Brent Mitchell, Roland Tilz, Peter Leong-Sit, Nikolaos Dagres
The purpose of this EP wire survey was to examine current practice in the management of both cavotricuspid isthmus : CTI)-dependent and non-CTI-dependent atrial flutter (AFL) ablation amongst electrophysiologists in European and Canadian centres and to understand how current opinions vary from guidelines. The results of the survey were collected from a detailed questionnaire that was created by the European Heart Rhythm Association Research Network and the Canadian Heart Rhythm Society. Responses were received from 89 centres in 12 countries...
January 5, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28056733/biomarker-assays-for-personalised-stroke-risk-assessment-in-atrial-fibrillation
#11
Angela Hall, Rupert Fg Simpson, Andrew Robert John Mitchell
Atrial fibrillation is a well-known independent risk factor for stroke yet there is no international consensus on guidelines regarding the introduction of anticoagulation in patients deemed at intermediate risk (e.g. CHA₂DS₂-VASc of 1). The evolution of cardiac biomarkers such as highly sensitive troponins and B-type natriuretic peptide as well as data on D-dimers, may offer incremental enhancements for personalised thromboembolism risk assessment. These markers provide prognostic data for risk of cardiovascular morbidities associated with atrial fibrillation and offer additional specificity for assessing stroke and thromboembolic risk...
January 4, 2017: Cardiovascular & Hematological Disorders Drug Targets
https://www.readbyqxmd.com/read/28056524/venous-thromboembolism-requiring-extended-anticoagulation-among-hiv-infected-patients-in-a-rural-resource-constrained-setting-in-western-kenya
#12
John Kanyi, Rakhi Karwa, Sonak Dinesh Pastakia, Imran Manji, Simon Manyara, Collins Saina
BACKGROUND: HIV-infected patients are at an increased risk of developing venous thromboembolism (VTE), and minimal data are available to describe the need for extended treatment. OBJECTIVE: To evaluate the frequency of and determine predictive risk factors for extended anticoagulation of VTE in HIV-infected patients in rural, western Kenya. METHODS: A retrospective chart review was conducted at the Anticoagulation Monitoring Service affiliated with Moi Teaching and Referral Hospital and the Academic Model Providing Access to Healthcare...
December 1, 2016: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28050712/optimizing-the-use-of-oral-anticoagulant-therapy-for-atrial-fibrilation-in-primary-care-a-pharmacist-led-intervention
#13
Mandeep S Virdee, Derek Stewart
Background Updated evidence-based guidelines for the management of atrial fibrillation (AF) necessitate patient review, particularly with respect to oral anticoagulants, to ensure maximum health gain around stroke prophylaxis. Objective To quantify the level of anticoagulation utilisation in patients with a CHA2DS2-VASc ≥1/≥2 (male/female) according to evidence-based guidelines and to assess the impact of a pharmacist-led intervention to optimise therapy. Setting Fifteen general medical practices in Liverpool, North-West England with a practice population of 99,129...
January 3, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28050066/antiphospholipid-syndrome-a-diagnostic-challenge
#14
REVIEW
R S Mallhi, Neerja Kushwaha, T Chatterjee, J Philip
The antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilic disorder that is characterized by thrombosis (venous, arterial and microvascular) and obstetric morbidity due to a diverse family of antibodies against phospholipid-binding proteins present in plasma. The term antiphospholipid antibody is actually a misnomer as the antibodies are not against the phospholipid per se, but target the plasma protein co-factors, which bind to anionic PLs. The exact etiology has not been elucidated and is multifactorial...
December 2016: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/28045591/clinical-practice-guideline-update
#15
Seth R Schwartz, Anthony E Magit, Richard M Rosenfeld, Bopanna B Ballachanda, Jesse M Hackell, Helene J Krouse, Claire M Lawlor, Kenneth Lin, Kourosh Parham, David R Stutz, Sandy Walsh, Erika A Woodson, Ken Yanagisawa, Eugene R Cunningham
Objective This update of the 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidence-based recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. Changes from the prior guideline include a consumer added to the development group; new evidence (3 guidelines, 5 systematic reviews, and 6 randomized controlled trials); enhanced information on patient education and counseling; a new algorithm to clarify action statement relationships; expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion; an enhanced external review process to include public comment and journal peer review; and 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care...
January 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28045242/evidence-for-periprocedural-antiplatelet-therapy-heparinization-and-bridging-of-coumarin-therapy-in-carotid-revascularization
#16
Art Brand, Gert J DE Borst
Thromboembolism prevention is a crucial factor determining both the natural outcome and outcome of intervention of stenotic atherosclerotic carotid artery pathology. Roughly 80% of all natural course cerebral ischemic events are caused by thromboembolism, versus 20% due to hemodynamic insufficiency. The risk of periprocedural cerebral (micro) thromboembolization during carotid revascularization is considered to be even higher, with a higher rate in carotid artery stenting (CAS) as compared to carotid endarterectomy (CEA)...
January 3, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28042443/differences-between-warfarin-and-new-oral-anticoagulants-in-dental-clinical-practice
#17
REVIEW
M Miranda, L S Martinez, R Franco, V Forte, A Barlattani, P Bollero
The oral anticoagulant therapy is used for the cure and the prevention of thromboembolic diseases. In the last fifty years the warfarin has been considered the oral anticoagulant of choice. However, its use is limited by a narrow therapeutic index and by a complex pharmacodynamics, which requires regular adjustments and monitoring of the dose. Recently, three new oral anticoagulant - dabigatran etexilato (direct thrombin inhibitor), rivaroxaban and apixaban (Xa factor direct inhibitor) - have been approved for use in europe...
July 2016: Oral & Implantology
https://www.readbyqxmd.com/read/28042233/gastrointestinal-endoscopy-in-patients-on-anticoagulant-therapy-and-antiplatelet-agents
#18
REVIEW
Angelo Zullo, Cesare Hassan, Franco Radaelli
Periprocedural management of antithrombotics for gastrointestinal endoscopy is a common clinical issue, given the widespread use of these drugs for primary and secondary cardiovascular prevention. For diagnostic procedures, with or without biopsy, no adjustments in antithrombotics are usually needed. For operative procedures, balancing the risk of periprocedural hemorrhage with the continuation of antithrombotics against the chance of recurrent thromboembolic events with their discontinuation may be challenging...
2017: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/28033586/core-shell-lc-ms-ms-method-for-quantification-of-second-generation-anticoagulant-rodenticides-diastereoisomers-in-rat-liver-in-relationship-with-exposure-of-wild-rats
#19
Isabelle Fourel, Marlène Damin-Pernik, Etienne Benoit, Virginie Lattard
Second generation anticoagulant rodenticides (SGARs), pesticides used worldwide to control rodent populations, exist in two diastereoisomer chemical species because they own two stereogenic centers. A core-shell LC-MS/MS multi-residue method for comprehensive quantitative analysis of the diastereoisomers of five SGARs as well as three first generation anticoagulant rodenticide molecules has been fully validated in liver of rats according to a bioanalytical guideline. A core-shell column (superficially porous particles) has been chosen for its ability to separate the diastereomers of bromadiolone, difenacoum, brodifacoum, flocoumafen and difethialone and for its robustness to rat liver extracts...
January 15, 2017: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
https://www.readbyqxmd.com/read/28029563/-use-of-non-vitamin-k-antagonist-oral-anticoagulants-in-primary-care-actua-study
#20
V Barrios, C Escobar, J M Lobos, J Polo, D Vargas
OBJECTIVES: Approximately 40% of patients with non-valvular auricular fibrillation (NVAF) who receive vitamin K antagonists (VKA) in Primary Care in Spain have poor anticoagulation control. The objective of the study Actuación en antiCoagulación, Tratamiento y Uso de anticoagulantes orales de acción directa (ACOD) en Atención primaria (ACTUA) (Action in Coagulation, Treatment and Use of direct oral anticoagulants [DOACs]) in Primary Care) was to analyse the current situation regarding the use of VKA and non-vitamin K antagonist oral anticoagulants (NOACs) in patients with NVAF in Primary Care in Spain and the possible issues arising from it...
October 28, 2016: Semergen
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