Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Feb 2011
Review Comparative StudyNew anticoagulants: pharmacology and clinical studies.
The marketing of new anticoagulant drugs has led us to review the development of rivaroxaban and apixaban (oral anti-Xa drugs) and dabigatran (an oral thrombin inhibitor). The results are different in terms of efficacy and tolerance. ⋯ Though the results are favourable for these orally active drugs in the orthopaedic setting, it is clear that only cardiological applications will give a final green light for these products. The future will be fascinating in this regard.
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Wien Med Wochenschr · Feb 2011
Awareness and use of recommendations for withholding and withdrawing therapy in Austrian intensive care units.
During the past decade there has been growing interest in the development of practice guidelines on medical end-of-life decisions. A questionnaire about awareness and use of end-of-life decision guidelines was applied by e-mail in a cross-sectional survey among 1494 attendants of Austrian intensive care medicine conferences held in 2008. ⋯ Those who read the recommendations at least in part believe to have derived benefit from the recommendations. Even though the response rate was low, Austrian intensive care medicine societies should be encouraged to better disseminate end-of-life decision guidelines among caregivers.
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During preoperative patient evaluation, anaesthesiologists assess the patient's bleeding history and risks for thrombosis and initiate individualized coagulation management. New potent anticoagulants may increase blood loss and the risk for spinal haematoma in patients scheduled for neuraxial anaesthesia. Postoperative start of thromboprophylaxis and recommendations on the timing of invasive interventions help in controlling these risks. Before widespread use for cardiological indications open questions need to be answered e.g. oral drug administration in postoperative vomiting and potential interactions with postoperative pain therapy.