Postgraduate medicine
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Postgraduate medicine · Jan 2013
ReviewAntiplatelet drug use in patients with non-ST-segment elevation acute coronary syndromes.
Patients with unstable angina pectoris/non-ST-segment elevation myocardial infarction have an acute coronary syndrome. These patients should be treated with dual antiplatelet therapy with the use of aspirin plus either clopidogrel, prasugrel, or ticagrelor, depending on the clinical circumstances. ⋯ Platelet glycoprotein IIb/IIIa inhibitors should not be used as part of triple antiplatelet therapy if there is an increased risk for bleeding or in non-high-risk patients, such as those with a normal baseline cardiac troponin level, those without diabetes, and those aged ≥ 75 years for whom potential benefit may be significantly offset by the potential risk for bleeding. Clinical trial data do not support the use of intravenous cangrelor or oral vorapaxar in the treatment of patients with acute coronary syndromes.
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Postgraduate medicine · Jan 2013
ReviewA review of antithrombotic therapy for transcatheter aortic valve replacement.
Aortic stenosis (AS) is a common valvular pathological finding in older adults. A latent period followed by rapid progression after the onset of symptoms can result in a high rate of death if left untreated. Aortic valve replacement (AVR) remains the standard of care for patients with severe symptomatic AS; however, due to comorbidities and age, patients may be ineligible for surgical AVR. ⋯ Intravenous unfractionated heparin titrated to target activated clotting times during the procedure and dual antiplatelet therapy before and after TAVR with aspirin and clopidogrel may be used. However, it is unclear which antithrombotic regimen may provide optimal protection for early and late thrombotic events in patients who undergo TAVR. This review evaluates the current guidelines, trials, and registry data discussing antithrombotic regimens for TAVR.
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Postgraduate medicine · Jan 2013
ReviewRuxolitinib: an oral Janus kinase 1 and Janus kinase 2 inhibitor in the management of myelofibrosis.
Myelofibrosis (MF), polycythemia vera (PV), and essential thrombocythemia (ET) are referred to as the classic Philadelphia chromosome (BCR-ABL1)-negative myeloproliferative neoplasms. Although each has distinct pathologic features, all 3 display alterations in Janus kinase (JAK) signal transduction activator of transcription signaling. Myelofibrosis is the most serious of the 3, associated with shortened survival (median survival, 5-7 years); bone marrow failure with anemia; progressive splenomegaly; and chronic, burdensome symptoms, including fatigue, night sweats, itching, abdominal discomfort, loss of appetite/early satiety, unintentional weight loss, and bone, chest, and abdominal pain. ⋯ Evidence also suggests that ruxolitinib therapy has a survival advantage over placebo and best available therapy. Thrombocytopenia and anemia were the most common adverse events with treatment. Ongoing trials are assessing the efficacy and safety of ruxolitinib therapy in patients with PV and ET.
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Postgraduate medicine · Jan 2013
ReviewViscosupplementation in patients with osteoarthritis of the knee.
Osteoarthritis (OA) of the knee is a chronic and progressive disease that is the product of failure of the joint to repair cartilage breakdown and wear. This article reviews the physiologic properties and pathological changes in the synovial fluid that occur in patients with OA. Exogenous hyaluronic acid (HA) has analgesic, chondroprotective, and disease-modifying effects. ⋯ Unlike other OA treatments, viscosupplements do not carry precautions for comorbidities, such as diabetes or cardiovascular disease. A number of HA viscosupplements are available for intra-articular injection in the treatment of knee OA. These supplements vary in molecular weight, dosage per injection, residence time in the joint, and number of injections required for treatment.