Dabigatran Case Studies

Coumadin (non specific name: warfarin) is an anticoagulant, or blood diminishing drug, that is endorsed to numerous patients who are at danger for creating blood clusters that could bring about heart assaults or strokes. Warfarin is near the most astounding purpose recently and simultaneous investigations of medications that provoke ER visits and occurring an expansion in healing center based offices with the affirmation of patients. Anticoagulation treatment stances perils to patients and over and over prompts unfavorable solution events in light of complex dosing, fundamental ensuing watching, and clashing patient consistence. As a result, various patients who meet current evidence based principles for warfarin treatment are not being managed

Human health and theIR quality of life have been improving in the past 100 due to changes in medicine and in public health (Mattes et al., 2013). Patients are placed on multiple medications at the same time and it important to understand their safety, efficacy, drug interaction, and toxicity (Mattes et al., 2013). As Mr. Cynthia Nurse practitioner, my job is to understand what affect her prescribing medication is having on her body. I have place Mrs. Cynthia on Lisinopril for her hypertension and metformin for her type II diabetes.

Stroke was defined as the sudden onset of a focal neurologic deficit in a location associated with the area of a major cerebral artery. The primary safety outcome was major hemorrhage and was defined as a reduction in the hemoglobin level of at least 20 g/L, transfusion of at least 2 units of blood, or symptomatic bleeding in a critical organ or area. Results were calculated using the Cox proportional-hazards modeling. Systolic embolism or stroke occurred in 199 patients receiving warfarin, 182 patients receiving 110 mg of dabigatran twice daily, and in 134 patients receiving dabigatran 150 mg twice daily. Major bleeding events occurred in 3.36% of participants per year with warfarin, 2.71% per year in patients that received 110 mg of dabigatran, and 3.11% per year in those receiving 150 mg of dabigatran. From calculated data, results revealed that dabigatran administered at a dose of 110 mg twice daily was non-inferior to that of warfarin. Lower rates of stroke were associated with dabigatran administered at a dose of 150 mg twice daily compared with that of warfarin. For safety, it was concluded that the risk of bleeding was lowest with dabigatran 110mg twice daily, and was similar between dabigatran 150 mg twice daily and

Other outcomes were myocardial infarction, ischemic stroke, systemic thrombosis, venous thrombosis in other areas of the body besides the legs, and even death. The patients underwent assessment either in the clinic or by telephone at days 30, 90, 180, 270, and 360. This study was consistent with other studies in the fact that the use of rivaroxaban reduced the risk of recurrent venous thromboembolism by about 70%. Rivaroxaban was found to be more effective than aspirin for the prevention of recurrent venous thromboembolism and was associated with a smaller risk of bleeding. The primary outcome occurred in 17 out of the 1,107 individuals who received 20 mg of rivaroxaban and in 13 out of the 1,127 individuals who received 10 mg of rivaroxaban. This was compared to 50 out of the 1,131 individuals who received aspirin once a day. Rates of bleeding were 0.5% in individuals who received 20 mg of rivaroxaban, 0.4% in individuals who received 10 mg of rivaroxaban, and 0.3% in individuals who received aspirin. For patients with venous thromboembolism who continued anticoagulation the risk of a repetitive event was lower with rivaroxaban at both 20 mg and 10 mg of treatment doses rather than with

Atrial fibrillation is the most frequent cardiac arrhythmia. There has always associated risk of clot formation and embolization that can lead to ischemic stroke. A large number of these ischemic events could be prevented by timely anticoagulation. Warfarin has been used for decades for this purpose, but there are many problems for the patients due to warfarin therapy like there is continuous need of INR monitoring, many food and drug interactions of the drug, late onset of action and risk of major bleeding. Anticoagulation with the Novel oral anticoagulants e.g. Dabigatran, rivaroxaban, apixaban, endoxaban led to similar or even lower rates of ischemic stroke and major bleeding compared to an adjusted dose of warfarin (INR 2-3) in patients

For many year’s patients with atrial fibrillation have been treated with anticoagulants such as Warfarin to prevent strokes and embolisms. Unfortunately, Warfarin must be closely monitored and that is an irritant for some patients. In October 2010, the FDA approved a new generational anticoagulant drug called Dabigatran (Pradaxa). This alternate medication gives patients the benefit of no dietary restrictions since dabigatran is not affected by certain foods. Another benefit of taking dabigatran is a monthly blood test is not required to measure its effectiveness, so for this particular reason many patients switch from taking other anticoagulants to dabigatran (Talati & White, 2011). Since this medication does not require close monitoring, some wonder if is it truly a better option or can more harm than good come from taking it. While the benefits of using dabigatran have shown significant improvement over warfarin, there are still risks associated with using dabigatran.

Warfarin is a prescription medicinal drug used to save you harmful blood clots from forming or developing large. useful blood clots prevent or prevent bleeding, but dangerous blood clots can reason a stroke, coronary heart attack, deep vein thrombosis, or pulmonary embolism. because warfarin interferes with the formation of blood clots, it's far referred to as an anticoagulant. Many humans check with anticoagulants as “blood thinners”; but, warfarin does now not thin the blood but rather reasons the blood to take longer to form a clot. Warfarin decreases the body’s capability to form blood clots through blocking the formation of diet k–established clotting elements. diet okay is needed to make clotting elements and prevent bleeding. therefore,

Azoulay, Dell’Aniello, Simon, Renoux, and Suissa (2013) performed a post-hoc nested-control analysis using the United Kingdom’s clinical practice research datalink database of 70,766 patients aged 18 years and older, who were diagnosed with atrial fibrillation between 1993 and 2008. Patients with less than one year of medical history in the database, as well as patients with a history of mitral or aortic valve repair or replacement, or patients with a history of hyperthyroidism were excluded from the study. By using conditional logistic regression, Azoulay et al. (2013) was able to determine that there was a 71% increase of stroke during the first 30 days of warfarin treatment, with a decreased risk after the first 30 days. Azoulay et al. (2013) goes on to conclude that warfarin-naïve patients (patients who have never taken warfarin previously) with atrial fibrillation might have a greater increased risk for thrombotic events during the first 30 days of warfarin initiation. Therefore, the study concluded that the increased clotting risk may be due to a warfarin induced hypercoaguable state, or it may be due to the extended time interval it takes for a therapeutic INR to be achieved by inexperienced warfarin

5. Based on this study, apixaban is superior to warfarin, but why in the clinical setting, warfarin is still the first line medication to be used in atrial fibrillation patients?

Antiplatelet therapy is the cornerstone of cardiovascular disease treatment. Clopidogrel in conjunction with aspirin has been shown to decrease cardiovascular mortality, repeat vascular events and stent thrombosis. As with any other antiplatelet agent, the increased risk of bleeding is the most common important complication of concern for physicians and patients alike. However, another important and possibly fatal condition to keep in mind is TTP.

Medications that can cause interactions include anticoagulants, probenecid, bisphosphonates, angiotensin-converting enzyme (ACE) inhibitors, anticoagulants (Warfarin), antiplatelet medicines (Clopidogrel), aspirin, corticosteroids (Prednisone), heparin, other NSAIDs (Ibuprofen), Rivaroxaban, or Selective Serotonin Reuptake Inhibitors (SSRIs) (Fluoxetine) due to the risk of stomach bleeding may be increased. Bisphosphonates (Alendronate), Cyclosporine, Hydantoins (Phenytoin), Lithium, Methotrexate, Quinolones (Ciprofloxacin), Sulfonamides (Sulfamethoxazole), and Sulfonylureas (Glipizide) side effects may be increased by Naproxen. The effectiveness of Angiotensin-converting enzyme (ACE) inhibitors (Enalapril), Beta-blockers (Propranolol), or diuretics (Furosemide, Hydrochlorothiazide) may be decreased by Naproxen (Lexi-Comp,

Gemfibrozil can interaction with many drugs. The drugs that have significant level drug interactions with gemfibrozil are warfarin and HMG-CoA reductase inhibitors.1 The authors in three case reports described patients who received gemfibrozil 1,200 mg daily with warfarin increased INR level or prothrombin time and the onset of this effect was delayed. Moreover two patients occurred bleeding symptoms such as fatigue, black stool and abnormal menstrual cycle. Furthermore when patients discontinued gemfibrozil, their’ INR turned into normal level and bleeding symptoms improved. Accordingly all these case report concluded gemfibrozil interaction with warfarin. However mechanism of this interaction is unclear but there are three assumptions that

Krishnan et al. (2008) studied 82 patients for post-op bleeding following dental extractions. They divided the patients into three groups, in which one group consisted of 35 patients whom their antiplatelet medications was suspended 10 days before surgery. The authors observed no significance difference in post-op bleeding between the three groups. Morimoto et al. (2010) reported similar results in their study which included 87 patients with no disruption in their antiplatelet medications. In addition, they found a few studies with patients receiving two antiplatelet medications simultaneously. Some studies reported no significant difference in bleeding tendency in such patients compared with individuals on a single antiplatelet medication. In contrast, one study reported a 40-50% increased risk in bleeding associated with dual antiplatelet medications compared with single medication. Lillis et al. (2011) studied 33 patients with dual antiplatelet medications and 78 patients receiving single antiplatelet medication. They reported increased bleeding with the group receiving dual antiplatelet medications. However, they mentioned that the bleeding was easily controlled with local hemostatic

According to the article “Anticoagulants: A Review of the Pharmacology, Dosing, and Complications” by Mohammed Alquwaizani, Leo Buckley, Christopher Adams, John Fanikos, anticoagulants persist as the primary strategy for preventing and treating thrombosis. Hemorrhage is a principal adverse event while using anticoagulant drugs.

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