The American journal of medicine
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The prevalence of atrial fibrillation increases with age, augmenting the risk of embolic stroke in elderly individuals. Clinical practice guidelines recommend the long-term use of oral anticoagulation in elderly patients with atrial fibrillation to reduce risk of stroke. Until recently, vitamin K antagonists (eg, warfarin) were the only oral anticoagulants available, but using warfarin in elderly patients can be challenging. ⋯ This review highlights the benefits and challenges of warfarin use in elderly patients with atrial fibrillation and discusses potential efficacy and safety benefits for newer oral agents in these patients. The potential for increased rates of major bleeding in the elderly, particularly those with numerous concomitant medications or renal impairment, also is discussed. Practical considerations for the use of long-term anticoagulation in elderly patients also are discussed.
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Given the huge burden of coronary artery disease and the effectiveness of medication therapy, understanding and quantifying known impacts of poor medication adherence for primary and secondary prevention is crucial. We sought to systematically review the literature on this topic area with a focus on quantified cost and clinical outcomes related to adherence. ⋯ Increased medication adherence is associated with improved outcomes and reduced costs, but most studies do not control for a "healthy adherer" effect.
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Comparative Study
Clinical outcomes after bedside and interventional radiology paracentesis procedures.
Increasingly, paracentesis procedures are performed in interventional radiology (IR) rather than at the bedside. No guidelines exist to aid decision-making about the best location, and patient outcomes are unknown. Our aims were to develop a prediction model for which location (bedside vs IR) clinicians select for inpatient paracentesis procedures, and to compare clinical outcomes. ⋯ The decision to perform a paracentesis procedure at the bedside or in IR is largely discretionary. Paracentesis procedures performed at the bedside result in equal or better patient outcomes. Clinicians should receive the training needed to perform paracentesis procedures safely at the bedside. Large prospective studies are needed to confirm the findings of this study and inform national practice patterns.