Hospital practice (1995)
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Hospital practice (1995) · Feb 2013
ReviewDual antiplatelet therapy with aspirin and clopidogrel: what is the risk in noncardiac surgery? A narrative review.
Clopidogrel is one of the most commonly prescribed medications and is currently recommended along with aspirin as treatment to be used for 1 year in all patients without contraindications following an acute coronary syndrome. Patients who are committed to clopidogrel therapy due to recent coronary artery stent implantation may require noncardiac surgery during this recommended period of dual antiplatelet therapy (DAPT). Due to differing rates of endothelialization, patients who undergo bare-metal stent implantation generally require ≥ 1 month of uninterrupted DAPT, and those who undergo drug-eluting stent implantation require ≥ 12 months. ⋯ References from extracted articles were also reviewed for relevant articles. Literature regarding perioperative clopidogrel continuation is predominantly composed of small, nonrandomized data, but suggests that most noncardiac surgeries or procedures can be performed safely while patients are taking clopidogrel. In this article, we review the current best evidence on the risk for bleeding with clopidogrel therapy in noncardiac surgery, summarize recent guidelines on appropriate duration of DAPT, and make recommendations on the management of perioperative DAPT.
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Hospital practice (1995) · Feb 2013
Evaluation of the utility of the Wells score in predicting pulmonary embolism in patients admitted to a spine surgery service.
A retrospective medical chart review of 4179 patients admitted to the spine surgery service. ⋯ The results of the CTPA did not show a significant correlation with the Wells score or the reason for the test. Our findings indicate the need to develop a predictive scoring system that assesses the risk of PE and assists in the decision-making process for ordering CTPA in spine surgery patients.
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Hospital practice (1995) · Feb 2013
Recent advances in antithrombotic therapy for stroke prevention in patients with atrial fibrillation.
Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia and patients with AF have a higher risk for stroke than the general population. The prevalence of AF is increasing, which underscores the importance of understanding the therapeutic options available for stroke prevention in the primary care setting. This article examines evidence for the use of novel oral anticoagulant (OAC) therapy, including the direct thrombin inhibitor dabigatran and the activated factor X inhibitors rivaroxaban and apixaban for stroke prevention in patients with AF. ⋯ Overall, the novel OACs are as good as, or better than, warfarin therapy for stroke prevention in patients with AF, and they have a comparable or reduced risk of associated major bleeding. In addition, the novel OACs have fewer drug-drug and food-drug interactions and do not require continuous blood monitoring. Integration of the novel OACs into clinical practice offers patients with AF new treatment options, and as therapeutic use of the novel OACs increases, real-world experience will add to our understanding of the value of these agents.