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Managing Anticoagulation Interruptions

Managing Anticoagulation Interruptions | Heart and Vascular Health | Scoop.it

On the ClotBlog with Dr. Samuel Z. Goldhaber, at theheart.org on Medscape speaking to you from the American College of Cardiology Scientific Symposium in Washington, DC. Today, I have a special guest and a special friend, Dr. Seth Bilazarian. Seth, welcome to the ClotBlog.

Today I wanted to discuss with you a problem that you and I get calls and emails about over and over again, and that is how to safely interrupt anticoagulation. There are several different levels that we can quickly talk about, including cataract surgery and colonoscopy, but then we can go into the more nitty gritty area of what do we do with patients who have mechanical heart valves. Let's start with cataract surgery. Do you ever instruct your patients to interrupt their anticoagulation?

Seth Bilazarian, MD's insight:

Discussion between a leading academic on thrombosis (Dr Goldhaber) and a community based practitioner (me) on the complexity of managing anti-coagulation around the time of a procedure or surgery.

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Thanks for the great plug on twitter : John Mandrola, MD ‏@drjohnm 

Grt discussion on interrupting anticoagulation w/@DrSethdb & Dr Goldhaber http://www.medscape.com/viewarticle/824855?utm_source=twitterfeed&utm_medium=twitter&nbsp;… < Like this topic b/c #judgement critical.

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Patients underestimate risk of warfarin emergencies

Patients underestimate risk of warfarin emergencies | Heart and Vascular Health | Scoop.it

Long-term users of warfarin (coumadin, a blood thinner) had difficulty recognizing the clinical severity and urgency of anticoagulation-related situations such as stroke symptoms and medication mismanagement.

69% of patients correctly answered questions about warfarin.  More than 50% of respondents correctly identified four of six urgent risk scenarios: acute chest pain (95%), taking the wrong dose of warfarin for a week or more (79%), head trauma (56%), and sudden headache (87%). Just 25% of respondents, however, recognized the urgency of acute unilateral vision loss as a possible sign of stroke and 20% recognized the urgency of a hit or bump on the head for bleeding risk.


Seth Bilazarian, MD's insight:

Warfarin is a complex medication that takes an enormous investment in teaching to be used safely.  All anticoagulants including the newer ones such as Pradaxa, Xarelto, Eliquis can cuase bleeding in the brain which is serious and life threatening.

 

The AHA has a public service program "Give me Five" warning signs of a stroke:

Sudden weakness or numbness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause

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Pradaxa turns 19 (in dog years)

Pradaxa turns 19 (in dog years) | Heart and Vascular Health | Scoop.it

As Pradaxa (dabigatran) celebrates its second anniversary since FDA approval, the clock is ticking to 2018, when its first patent is set to expire.  What are the impediments to new blood thinners despite a strong set of data from the development of this first in class new blood thinner. My thoughts in theheart.org Vlog.

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Bridging Anticoagulation

Bridging Anticoagulation | Heart and Vascular Health | Scoop.it

Cardiology Patient Page
Bridging Anticoagulation
Is it Needed When Warfarin Is Interrupted Around the Time of a Surgery or Procedure?

from the  The BRIDGE Study Investigators

 

There are many patients who are receiving long-term treatment with the blood thinner warfarin, whether because of atrial fibrillation (the commonest reason for taking warfarin) or a mechanical heart valve. Such patients frequently require warfarin to be stopped because of an upcoming surgery/procedure. There is uncertainty whether such patients should receive bridging anticoagulation before and after the surgery/ procedure.

 

For patients interested in learning more about this trial happening in Haverhill at PMA see...

 

http://www.pmaonline.com/clinical-trials.htm

 

 

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What to do about bridging with novel oral anticoagulants

What to do about bridging with novel oral anticoagulants | Heart and Vascular Health | Scoop.it

Sharing a rare moment of person-to-person time during the scientific sessions in San Francisco, Dr Seth Bilazarian asks Dr. Samuel Goldhaber how he goes about bridging with "Novel oral anticoagulants" (NOACs) #dabigatran, #rivaroxaban, and #apixaban.

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Caution on initial bleeding risk with warfarin

Caution on initial bleeding risk with warfarin | Heart and Vascular Health | Scoop.it

My comment: We have new options for patients with atrial fibrillation.  These new drugs Pradaxa and Xarelto are under scrutiny because they are new nadn bleeding hazard has been reprted.  This study helps us understand that warfarin (coumadin) also has significcant risk and the risk is high in the first week of starting thsi medicine.  This early hazard but be an advatage for the newer options.

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Rates of serious bleeding among patients taking warfarin are much higher than those found in clinical trials of the drug and are even greater during the first month of use, according to a five-year study of 125,195 seniors with atrial fibrillation.

The findings complicate an already difficult decision-making process for patients with atrial fibrillation (AF) and highlight the importance of careful management of warfarin, especially during the first month of use, experts said. Warfarin is a generic anticoagulant that is marketed under brand names such as Coumadin and Jantoven.

Compared with clinical trials for warfarin that found serious hemorrhaging rates of between 1% and 3% per year, bleeding problems are more common in real-life clinical practice, said the study, published Nov. 26 in the Canadian Medical Assn. Journal. In the study, the overall rate of hemorrhaging — bleeds serious enough to send patients to the hospital — was 3.8% per person, per year.

However, during the first month of treatment, the annualized hemorrhage rates were 11.8% in all patients and 16.7% among patients with higher risk of stroke. 

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2012 ACCP Guidelines – DVT and PE: Highlights and Summary

2012 ACCP Guidelines – DVT and PE: Highlights and Summary | Heart and Vascular Health | Scoop.it

The 2012 ACCP Guidelines on treatement for DVT and PE is 802 pages long.  What it has in comprehensiveness it lacks in user friendliness.  This highlight & summary document on one page is a great resource.  It highlights changes especially in duration of treatment for Pulmonary embolism (PE) & Deep venous thrombosis (DVT) patients.

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