Recent advances in management of anti-coagulation in Atrial Fibrillation
Role of anti-coagulation in prevention of stroke in Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is more prevalent in men with increasing age. ( 11343485). Hypertensive heart disease and coronary heart disease are most common underlying disorders in patients with AF in developed countries. AF is classified based on 2014 AHA/ACC/HRS guidelines into Paroxysmal AF (AF that terminates spontaneously in less than 7 days), persistent AF (AF that fails to terminate in 7 days), long standing persistent AF (AF more than 12 months) and permanent AF (AF that is considered not amenable to rhythm control strategy). This classification
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(20569748).
For non-valvular AF with CHAD2S2-Vasc score 2 or more than 2, benefits of oral anti-coagulation therapy (OAC) exceeds risk as shown in several studies. (22514252, 19721017, 21789337, 22186961). Scores of 1 entails various approaches for anti-coagulation depending on several factors including but not limited to patient’s age, safety, bleeding risks etc. For patients with score of 0, the risk of anti-coagulation outweighs the benefits, so no anti-coagulation is needed. Based on these findings, OAC is class 1 indication for patients with CHA2DS2-VASc score of 2 or more. (23558044, 22922413).
Benefits of New non-vitamin K oral anti-coagulants
Traditionally, warfarin has been the drug of choice for long term anti-coagulation in AF after initial bridging with heparin. Recently, newer non-vitamin K oral anti-coagulants (NOACs) are available for long term anti-coagulation in AF. These drugs inactivate both circulating and clot bound activated coagulation factors.(see figure 1 for mechanism of action). The two major class of NOAC available are direct thrombin inhibitor (DTI) and factor Xa inhibitor. Parenteral direct thrombin inhibitors include bivalirudin, argatroban and lepirudin. Oral direct thrombin inhibitors include dabigatran. Oral factor Xa inhibitors
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
In 1865, nearly ninety years after the founding of the United States, the Thirteenth Amendment to the Constitution was ratified, thereby abolishing the “peculiar institution” which had once threatened to end the Great Experiment of American Democracy. Two subsequent amendments, ratified in 1868 and 1870, guaranteed equal protection of the law to all citizens and prohibited the denial of voting rights on the basis of race, color, or previous condition of servitude. Yet, close to one hundred years after these three Reconstruction Amendments became the law of the land, racial equality was still something confined to the dreams of visionaries and activists. Writing a letter from Birmingham Jail in Alabama, civil rights leader Martin Luther King
There are many people that suffer from venous thromboembolism. Venous thromboembolism includes both deep vein thrombosis and pulmonary embolism. This is the third most common cause of vascular death after a myocardial infarction, also known as a heart attack, and stroke. This article examines the possibility of either full or low intensity anticoagulation therapy versus aspirin. This was a randomized study that consisted of 3,396 individuals who have venous thromboembolism. These individuals either received rivaroxaban, which is an anticoagulant, or 100 mg of aspirin once a day. The individuals in this study completed 6-12 months of anticoagulation therapy and were eligible for inclusion in the study if they were 18 years of age or older. The
These TPAs are agents used to start hemostasis by converting plasminogen into plasmin, allowing fibrinolysis to occur (Alteplase). Hemostasis starts and it includes three processes combined that work together prevent or control blood loss (Alteplase). These three stages are vascular constriction, formation of the platelet plug and blood coagulation (Grossman, p.g.674). This means that Ronald is not a candidate for this medication since he is experiencing signs and symptoms of hemorrhagic stroke and this drug can make the bleed worsen due to clot dissolving mechanism. It is contraindicated to give a TPA to a patient experiencing an intracranial hemorrhage or active bleeding (Alteplase). Although he may not be able to have a TPA, he would be able to have medications that will try to help decrease his blood pressure and brain
Anticoagulant therapy will started according to facility protocol. This therapy will decrease the blood’s ability to clot, and help to prevent the formation of new clots. Anticoagulants used will be warfarin, heparin, or coumadin. In facility therapy will be initiated via IV push according to facility protocol, with continuous monitoring of patient condition.
Anticoagulants are a type of drug that reduces the body’s ability to form blood clots in the blood by inhibiting the production of vitamin K in the liver. The goals of the anticoagulant therapy are to prevent stroke in patients with atrial fibrillation and artificial heart valves. In patients with PE/DVT, the primary goal of the anticoagulant is to prevent an existing clot from getting larger. Anticoagulant drugs can be used after surgery to prevent new blood clots. Anticoagulant drugs increase the risk of bleeding. Because of this risk, it is essentially important to educate the patient to take the medication exactly as directed and never take larger or more frequent doses. The challenges of anticoagulant therapy are to keep it in the therapeutic
Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med. 1995; 155:469-73.
Platelet transfusions may be given to people who are having severe bleeding episode. Minor bleeding from sites that can be seen, such as teeth and gums can be controlled by a local application of thrombin. Nosebleeds may require nasal packing (cocaine has been used on packing material) as well as platelet transfusion. Antifibrinolytic drugs (rare) may help control bleeding and tooth decay. Heavy menstrual cycles may require hormonal therapy to help control bleeding. Patients are likely to require multiple transfusions during their lifetime; doctors try to avoid platelet alloimmunization. Prevention of alloimmunization is best accomplished by using leukocyte depleted blood products. The only way to accomplish blood products with leukocyte depletion is with mechanical filtration. Only filtered blood products should be given. Another attempt in preventing alloimmunization is the use of HLA- matched platelets. Patients should be vaccinated for hepatitis B, due to the risk of infection associated with multiple transfusions. Patients should always avoid medications that affect platelet functions, such as aspirin in known blood thinners like warfarin. They should also avoid any nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen and naproxen. These drugs can prolong bleeding
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.
3.) The founders of The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines are:
Vitamin E may enhance antiplatelet effects and anticoagulant therapy. Monitoring will need to be done on this patient since he is also taking warfarin and aspirin. ( cite)
The evidence based practice process gives more evidence of young patients with few risk factors and no structural heart defect, the benefits of anticoagulation may be outweighed by the risks of haemorrhage (bleeding). High quality guidelines and the systematic searches used for the topic in this portfolio were beneficial. Use of a rigorous and transparent process in this portfolio for identifying, appraising and adopting/ adapting guidelines are crucial to help for the decision making. A major factor that stops the usage of the new drug is unfortunately, there are no specific antidotes to reverse the coagulant effects of the direct thrombin or factor Xa
Preventing errors relating to commonly used anticoagulants. (2008). Joint Commission perspectives. Joint Commission on Accreditation of Healthcare Organizations, 28(11), 13-15.
Marijuana, the gate way drug. Everyone thinks it's only bad, that it only leads to bad stuff. There are two sides of cannabis, medical and recreational. Medical isn't the good and recreational isn't the bad, it's how they're used. And they can both be used for good. Mentioned in a Chinese herbal dating from 2700 before Christ, marijuana has long been considered valuable as an analgesic, and anesthetic, and anti-depressant, an antibiotic, and a sedative. To understand the use of marijuana one must know the affects, the causes, and what it can do as treatments.
It seems as though organized religion, specifically Christianity, has always reacted with hostility towards scientific advancements. Examples of the church’s animosity towards scientific discoveries that threatened their power, influence, and credibility plague the history books. During the Renaissance and Scientific Revolution many scientists were ostracized from the church for their theories and discoveries. For example, Giordono Bruno, a follower of the Hermetic tradition and an outspoken supporter of the Copernican theory, was summoned by the church to appear before an Inquisition whereby he was found guilty of blasphemy and condemned to death. He was burned at the stake in 1600 (Perry, 70). Galilei Galileo and