The Annals of pharmacotherapy
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To describe management of anticoagulation with a decreased dose requirement of bivalirudin during cardiopulmonary bypass using deep hypothermic circulatory arrest (DHCA) and the reversal of the ensuing coagulopathy with recombinant factor VIIa (rFVIIa). ⋯ In the setting of DHCA, bivalirudin should be used cautiously, with frequent monitoring of the ACTs and potential cessation of the infusion in anticipation of prolonged drug effect with subsequent potential coagulopathy. If coagulopathy ensues, use of low-dose rFVIIa may be an option to initiate hemostasis. When using rFVIIa, it is important to consider the risk of thrombosis and monitor patients accordingly.
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Comparative Study
P2Y₁₂ receptor inhibitors: integrating ticagrelor into the management of acute coronary syndrome.
Acute coronary syndrome (ACS) is a continuum of disease that includes non-ST-segment elevation ACS and ST-segment elevation myocardial infarction. The purpose of this article is to define the developing role of ticagrelor in ACS and compare it to currently available P2Y₁₂ receptor inhibitors. ⋯ Although ticagrelor offers important advances in the management of ACS (eg, reversibility), there are also notable clinical considerations (eg, unique adverse effects such as dyspnea). Based on the current evidence, we propose an algorithm to aid clinicians in the selection of a P2Y₁₂ receptor inhibitor for patients with ACS in various clinical situations.
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Innovation in health care is difficult yet necessary in this era of health care delivery and payment reform. The Center for Medicare and Medicaid Services (CMS) Innovation Center and the CMS Partnership for Patients have announced priority areas to achieve better health, better care, and reduced costs through continuous improvement. Pharmacists possess the therapeutic knowledge and medication process expertise to create collaborative and innovative solutions that address medication use and safety problems. ⋯ As pharmacy practitioners, educators, and researchers, we face an unprecedented opportunity to make a difference. So, either individually or collectively in our workplaces and pharmacist professional organizations, we must respond to this call to action. Some practical suggestions are offered to get us started on this journey.