Aust Prescr
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Review
Balancing the benefits and harms of oral anticoagulation in non-valvular atrial fibrillation.
Non-valvular atrial fibrillation is becoming more common in Australia and globally The direct oral anticoagulants apixaban, dabigatran and rivaroxaban offer an improved safety profile over warfarin Patient preferences are important and shared decision-making supports better adherence to treatment.
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Patients with epilepsy who have been free of seizures for at least two years may be able to stop their antiepileptic drugs. Discontinuation may be considered after an individualised harm-benefit assessment and consultation with a neurologist is recommended. It is paramount to discuss with patients whether the risk of seizure recurrence is worth the benefit of stopping the antiepileptic drug. ⋯ Approximately 30-50% of patients will relapse. If seizures recur, the majority of patients regain seizure control when treatment is resumed. However up to 20% do not achieve immediate remission.
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Palliative care is the province of everyone, particularly people managing older patients. Most people die of multimorbidity, frailty and dementia rather than cancer and will never see a palliative care specialist. People dying from non-malignant disease have symptoms and problems that are usually predictable. ⋯ Deprescribing is an effective way of preventing morbidity in this group. Getting to know a few medicines well for each symptom is important when providing palliative care for patients. Starting at low doses and increasing slowly is also key.