Objectives. Case Ruby. 1- Warfarin. 1- Warfarin. Warfarin discontinuation 8/13/ DRUGS TO STOP GIVING HOSPICE PATIENTS
|
|
- Bernadette Rice
- 5 years ago
- Views:
Transcription
1 Objectives 10 DRUGS TO STOP GIVING HOSPICE PATIENTS Richard E. Allen MD, MPH Hospice Medical Director Family Medicine Residency Director Salt Lake City, Utah 2 Recognize 10 commonly prescribed medications with little or no benefit in hospice patients Use evidence and finesse to negotiate with patients and caregivers Apply hospice principles of comfort care and dignity in treating patients Case Ruby 1- Warfarin 3 82 debility: weight loss, bedridden, pneumonia, 6/6 ADLs A-fib, GERD, dementia, hypertension, recurrent UTI Rx warfarin, omeprazole, simvastatin, donepezil, nitrofurantoin, tylenol, baby aspirin, vitamins 4 Anticoagulant through Vit K inhibition Atrial fibrillation Thromboembolism (DVT, PE) Valvular heart disease Protime (International Normalized Ratio, INR) 1- Warfarin Warfarin discontinuation 5 Stroke risk on Rx 2% Stroke risk off Rx 4% CHA 2 DS 2 -VASc score Age>75, female, hypertension = 4 points Bleeding risk on Rx 8.4% HEMORR2HAGES index Age>75, hypertension, fall risk= 3 points Major bleed risk (intracranial, GI) increase with aspirin, nsaids, elderly 6 Comfort care principles Dignity in death Complications of monitoring Risk > benefit Too many pills 1
2 7 2- Statins Inhibit HMG-CoA reductase in cholesterol synthesis Widespread use for preventive and secondary treatment 8 Cholesterol in older adults Plateau after age 50 J-shaped curve cholesterol : death Increased adverse effects Cost of treatment and monitoring Clinical trials are long term (6 years) Association with memory loss? Patients with a limited life span from a concomitant illness are probably not candidates for drug therapy 9 Case Violet 66 lung cancer: cachexia, cough, oxygen, PPS 60% CAD with stent 4 years ago Osteoporosis, hypothyroidism Rx clopidogrel, aspirin, levothyroxine, alendronate, metoprolol, furosemide, lorazepam, atorvastatin, inhalers Clopidogrel Anti-platelet therapy Dual antiplatelet therapy (DAPT) with aspirin Post-stent treatment 1-6 months Stable CAD treatment? Stroke prevention? Clopidogrel CHARISMA trial 15,000 patients no CAD benefit Doubled GI bleeding with ASA MATCH trial 7500 patients Risk > benefit Stent studies 1-month benefit with metal, 6- month with eluting CAPRIE 19,000 patients NNT 200 over 2 years to prevent 1 stroke 12 Clopidogrel cost Plavix $ /month Aspirin cost $11,000 per year of life gained Plavix cost $130,000 per year of life gained 2
3 13 4- Furosemide Diuresis for fluid overload/retention Loop of Henle Furosemide Increase norepinephrine, renin, vasopressin Chronic use resistance, blunted vasodilation Decrease renal blood flow, Cr Orthostasis, electrolyte abnormalities Indications: acute decompensated heart failure, clinical symptomatic fluid overload 15 Case EmmaLou 96 dementia: FAST 7C, PPS 20% Memory-care unit for years Osteoporosis, hypothyroidism, distant history coronary artery disease, diabetes Rx aspirin, levothyroxine, ibandronate, glyburide, memantine, risperidone Bisphosphonates Osteoporosis treatment 50% decrease in fracture at 36 months 3-5 years = 10 years protection drug holiday 3-5 years Hypercalcemia tratment Bisphosphonates Must be taken fasting with 8 oz. water Must remain standing or upright 30 minutes Not recommended for Cr clearance <35 ml/min 3-5 years = 10 years protection Long-term medication, studies 3-5 years esophagitis Cholinesterase inhibitors Treatment of mild to moderate Alzheimers Questionable use in severe dementia Some effect seen in other dementias and brain syndromes Effect is clinically marginal 0.1 SDs on ADL scales 0.09 SDs on instrumental ADL (IADL) scales 3
4 6- donepezil (dementia treatment) 7- Sulfonylureas Diabetes treatment Pancreatic beta-cell secretion of insulin Commonly used well beyond effective time A1c goals < 7% for fit patients with 10-year life expectancy 7 7.9% for patients with cardiovascular disease 8% for frail elderly and/or multiple co-morbidities 21 Hypoglycemia Increased in elderly Short- and long-term cognitive impairment Delirium, weakness, dizziness 22 Case Harold 86 COPD Hypoxia, cachexia Dysphagia, history esophageal stricture Rx multivitamin, fish oil, B12 shot, Vit C, Calcium, Vit D, ramipril, amlodopine, clonidine, atorvastatin, omeprazole, allopurinol, montelukast, mirtazapine, buproprion, lorazepam, 3 inhalers 23 pills per day Vitamins Anti-hypertensves Trial Subjects Mean age Mean BP Duration SHEP /77 5 years Syst-Eur /86 4 years MRC / years HYVET /91 2 years 4
5 9- Anti-hypertensves 10- Antidepressants 25 To treat Target 150/80? Symptoms?? or not to treat Orthostasis falls Fatigue Renal insufficiency Cough Edema 26 Beers list 2012 STOPP screening tool of older persons potentially inappropriate prescriptions START screening tool to alert doctors to right treatment 10- Antidepressants 10 Drugs to Stop on Hospice patients 27 Antipsychotics (> 1 month) Most common potentially inappropriate type of medication used in nursing homes Double risk of death Benzodiazepines Increased confusion and fall risk Selective serotonin reuptake inhibitors Increased fall risk (odds ratio = 1.72) even more than tricyclic antidepressants (odds ratio = 1.51) 28 Warfarin Statins Clopidogrel Furosemide Bisphosphonates Donepezil Sulfonylureas Vitamins Anti-hypertensives Anti-depressants 29 References Gage BF et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151(3):713. Agarwal S et al. Current trial-associated outcomes with warfarin in prevention of stroke in patients with nonvalvular atrial fibrillation: a meta-analysis. Arch Intern Med. 2012;172(8):623. Evans MA. Statin-associated adverse cognitive effects: survey results from 171 patients. Pharmacotherapy. 2009;29(7): Corti MC et al. Clarifying the direct relation between total cholesterol levels and death from coronary heart disease in older persons. Ann Intern Med. 1997;126(10):753 Bhatt DL et al CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354(16):1706 Diener HC et al MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364(9431): References CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329 Grinstead WC et al. Discontinuation of chronic diuretic therapy in stable congestive heart failure secondary to coronary artery disease or to idiopathic dilated cardiomyopathy. Am J Cardiol. 1994;73(12):881 Black DM et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348(9041):1535 Courtney C et al, AD2000 Collaborative Group. Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial. Lancet. 2004;363(9427):2105. Raina P et al. Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Ann Intern Med. 2008;148(5):379. 5
6 References 31 Gerstein HC et al. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545. Whitmer RA et al. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301(15):1565 Odden MC et al. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med. 2012;172(15):1162. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):
MEDICATION APPROPRIATENESS FOR THE AGING POPULATION. Building Partnerships for Successful Aging
MEDICATION APPROPRIATENESS FOR THE AGING POPULATION Building Partnerships for Successful Aging Learning objectives Appreciate complexities involved in making appropriate clinical decisions in older adults
More information:{ic0fp'16. Geriatric Medicine: Optimal Heart Health Amid Changing Guidelines. (and the Evidence for When to Stray) Kevin Overbeck, DO
:{ic0fp'16 ACOFP 53 rd Annual Convention & Scientific Seminars Geriatric Medicine: Optimal Heart Health Amid Changing Guidelines (and the Evidence for When to Stray) Kevin Overbeck, DO Optimal Heart Health
More informationDeconstructing Polypharmacy. Alan B. Douglass, M.D. Director
Deconstructing Polypharmacy Alan B. Douglass, M.D. Director Recognize this patient? Mrs. Brown- 82 years young Active Medical Problems Hypertension Hyperlipidemia Type 2 Diabetes Peripheral edema Osteoarthritis
More informationSTOPP and START criteria October 2011
# START and STOPP are newer criteria to identify potentially inappropriate medications in elderly, including drug drug and drug disease interactions, drugs which increase risk of falls and drugs which
More informationManagement of Patients with Atrial Fibrillation Undergoing Coronary Artery Stenting 경북대의전원내과조용근
Management of Patients with Atrial Fibrillation Undergoing Coronary Artery Stenting 경북대의전원내과조용근 Case (2011, 5) 74-years old gentleman Exertional chest pain Warfarin with good INR control Ex-smoker, social(?)
More informationPCI in Patients with AF Optimizing Oral Anticoagulation Regimen
PCI in Patients with AF Optimizing Oral Anticoagulation Regimen Walid I. Saliba, MD Director, Atrial Fibrillation Center Heart and Vascular Institute Cleveland Clinic 1 Epidemiology and AF and PCI AF and
More informationRole of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University
Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without
More informationNew Clinical Trends in Geriatric Medicine. April 8, 2016 Amanda Lathia, MD, MPhil Staff, Center for Geriatric Medicine
New Clinical Trends in Geriatric Medicine April 8, 2016 Amanda Lathia, MD, MPhil Staff, Center for Geriatric Medicine Objectives Review current guidelines for blood pressure (BP) control in older adults
More informationIndications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute
Indications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute Disclosures Research Support/P.I. Employee Leo Pharma
More informationCondition/Procedure Measure Compliance Criteria Reference Attribution Method
Premium Specialty: Cardiology Credentialed Specialties include: Cardiac Diagnostic, Cardiology, Cardiovascular Disease, Clinical Cardiac Electrophysiology, and Interventional Cardiology This document is
More informationDual antiplatelet therapy (DAPT) in the era of Novel Oral Anticoagulants (NOACs) SACIS 2015
Dual antiplatelet therapy (DAPT) in the era of Novel Oral Anticoagulants (NOACs) SACIS 2015 Wesam A Alhejily MD FRCPC FACP FACC FSCAI Assistant Professor of Medicine Chief Of Adult Cardiology Consultant
More informationDr Julia Hopyan Stroke Neurologist Sunnybrook Health Sciences Centre
Dr Julia Hopyan Stroke Neurologist Sunnybrook Health Sciences Centre Objectives To learn what s new in stroke care 2010-11 1) Acute stroke management Carotid artery stenting versus surgery for symptomatic
More information03/30/2016 DISCLOSURES TO OPERATE OR NOT THAT IS THE QUESTION CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE
CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE Elizabeth L. Detschelt, M.D. Allegheny Health Network Vascular and Endovascular Symposium April 2, 2016 DISCLOSURES I have no
More informationGeriatric Pharmacology
Geriatric Pharmacology Janice Scheufler R.Ph.,PharmD, FASCP Clinical Pharmacist Hospice of the Western Reserve Objectives List three risk factors for adverse drug events in the elderly Discuss two physiological
More informationAntithrombotics in Stroke management
Antithrombotics in Stroke management Faculty: Robert Beveridge Relationships with commercial interests: Grants/Research Support: N/A Speakers Bureau/Honoraria: Astra Zeneca, Bayer, Boerhinger Ingelheim,
More informationHow Long Patietns Will Be on Dual Antiplatelet Therapy?
How Long Patietns Will Be on Dual Antiplatelet Therapy? Ron Waksman,, MD, FACC Professor of Medicine (Cardiology) Georgetown University Associate Director, Division of Cardiology, Washington Hospital Center
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Olesen JB, Lip GYH, Kamper A-L, et al. Stroke and bleeding
More informationSUPPLEMENTAL MATERIAL
SUPPLEMENTAL MATERIAL 1 Supplemental Table 1. ICD codes Diagnoses, surgical procedures, and pharmacotherapy used for defining the study population, comorbidity, and outcomes Study population Atrial fibrillation
More informationPrimary Prevention of Stroke
Primary Prevention of Stroke Dr Chris Ellis Cardiologist Green Lane CVS Service, Auckland City Hospital & Auckland Heart Group, Mercy Hospital, Auckland 67 Pages Long, 735 References 29 Sub-Headings for
More informationNeuroPI Case Study: Anticoagulant Therapy
Case: An 82-year-old man presents to the hospital following a transient episode of left visual field changes. His symptoms lasted 20 minutes and resolved spontaneously. He has a normal neurological examination
More informationSTOPP START Toolkit Supporting Medication Review in the Older Person
STOPP START Toolkit Supporting Medication Review in the Older Person STOPP: Screening Tool of Older People s potentially inappropriate Prescriptions START: Screening Tool to Alert doctors to Right (appropriate,
More informationCondition Congestive heart failure I11.0; I13.0; I13.2; I42.0; I50 CO3C Left ventricular dysfunction I50.1; I50.9 E11 1; E11 9
Comparative effectiveness and safety of non-vitamin K antagonists oral anticoagulants (OACs) and warfarin in daily clinical practice: A propensity weighted nationwide cohort study. Supplementary material
More informationNUOVI ANTICOAGULANTI NELL ANZIANO: indicazioni e controindicazioni. Mario Cavazza Medicina d Urgenza Pronto Soccorso AOU di Bologna
NUOVI ANTICOAGULANTI NELL ANZIANO: indicazioni e controindicazioni Mario Cavazza Medicina d Urgenza Pronto Soccorso AOU di Bologna Two major concerns Atrial Fibrillation: Epidemiology The No. 1 preventable
More informationCOMMON DRUG RELATED PROBLEMS SEEN IN PACE AND MECHANISMS TO MITIGATE RISK
COMMON DRUG RELATED PROBLEMS SEEN IN PACE AND MECHANISMS TO MITIGATE RISK Robert L Alesiani, PharmD, CGP Chief Pharmacotherapy Officer CareKinesis, Inc. (a Tabula Rasa Healthcare Company) 2 3 4 5 Pharmacogenomics
More informationUpdate in Outpatient Medicine ACP Scientific Session November 12, 2016
Update in Outpatient Medicine ACP Scientific Session November 12, 2016 Robert Gluckman MD, MACP Chief Medical Officer Providence Health Plans Disclosures Stock Holdings Abbott Labs Abbvie Bristol Myers
More informationAtrial Fibrillation and Heart Failure: A Cause or a Consequence
Atrial Fibrillation and Heart Failure: A Cause or a Consequence Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania November
More informationBranko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center
Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center THE END! CHANGABLE Blood pressure Diabetes Mellitus Hyperlipidemia Atrial fibrillation Nicotine Drug abuse Life style NOT CHANGABLE
More information3/23/2017. Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate Europace Oct;14(10): Epub 2012 Aug 24.
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017 Explain the efficacy and safety of triple therapy, in regards to thromboembolic and bleeding risk Summarize the guideline recommendations
More informationAngelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017 Explain the efficacy and safety of triple therapy, in regards to thromboembolic and bleeding risk Summarize the guideline recommendations
More informationApixaban for Atrial Fibrillation in Patients with End-Stage Renal Disease on Dialysis
Apixaban for Atrial Fibrillation in Patients with End-Stage Renal Disease on Dialysis Caitlin Reedholm, PharmD PGY1 Pharmacy Resident St. David s South Austin Medical Center November 2, 2018 Abbreviations
More informationPharmaceutical Care for Geriatrics
Continuing Professional Pharmacy Development Program Pharmaceutical Care for Geriatrics Presented by: Alla El-Awaisi; MPharm, MRPharmS, MSc Event Organizer: Dr. Nadir Kheir; PhD Disclaimer: PRESENTING
More informationPolypharmacy in the Elderly
Polypharmacy in the Elderly Or How Scotland invented the Modern World Sir William Ferguson Anderson 1914-2001 Became the first Professor of Geriatrics in the world when he was appointed to the David Cargill
More informationTransitions of Care & Medication Reconciliation Ashley King, PharmD, BCGP Clinical Pharmacist LECOM Health March 2018
Transitions of Care & Medication Reconciliation Ashley King, PharmD, BCGP Clinical Pharmacist LECOM Health March 2018 Objectives Identify when to complete medication reconciliation Understand the importance
More informationATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION
ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION Frederick Schaller, DO, MACOI,FACP Adjunct Clinical Professor Touro University Nevada DISCLOSURES I have no financial relationships
More informationAsif Serajian DO FACC FSCAI
Anticoagulation and Antiplatelet update: A case based approach Asif Serajian DO FACC FSCAI No disclosures relevant to this talk Objectives 1. Discuss the indication for antiplatelet therapy for cardiac
More informationUpdate in the Literature 2012
Update in the Literature 2012 Mel L. Anderson, MD, FACP Chief, Hospital Medicine Section Associate Chief, Medical Service Denver VA Medical Center Associate Professor of Medicine University of Colorado
More informationNew options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital
New options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital Disclosures: Honoraria, research support, and consulting f Sanofi, Boehringer-Ingleheim, Portola, BMS, Bayer,
More informationAspirin to Prevent Heart Attack and Stroke: What s the Right Dose?
The American Journal of Medicine (2006) 119, 198-202 REVIEW Aspirin to Prevent Heart Attack and Stroke: What s the Right Dose? James E. Dalen, MD, MPH Professor Emeritus, University of Arizona, Tucson
More informationEvaluate Risk of Stroke & Bleeding in AF Patients
XV World Congress of Arrhythmias, Beijing, China - 17-20 September, 2015 Evaluate Risk of Stroke & Bleeding in AF Patients Antonio Raviele, MD, FESC, FHRS President ALFA Alliance to Fight Atrial fibrillation
More informationResults from RE-LY and RELY-ABLE
Results from RE-LY and RELY-ABLE Assessment of the safety and efficacy of dabigatran etexilate (Pradaxa ) in longterm stroke prevention EXECUTIVE SUMMARY Dabigatran etexilate (Pradaxa ) has shown a consistent
More informationMultidisciplinary Geriatric Trauma Care Guideline
Multidisciplinary Geriatric Trauma Care Background Traumatic injury in the geriatric population is increasing in prevalence and is associated with higher mortality and complication rates comparted to younger
More informationMODULE 1: Stroke Prevention in Atrial Fibrillation Benjamin Bell, MD, FRCPC
MODULE 1: Stroke Prevention in Atrial Fibrillation Benjamin Bell, MD, FRCPC Specialty: General Internal Medicine Lecturer, Department of Medicine University of Toronto Staff Physician, General Internal
More informationLow Dose Rivaroxaban Versus Aspirin, in Addition to P2Y12 Inhibition, in Acute Coronary Syndromes (GEMINI-ACS-1)
Low Dose Rivaroxaban Versus Aspirin, in Addition to P2Y12 Inhibition, in Acute Coronary Syndromes (GEMINI-ACS-1) Caitlin C. Akerman, PharmD PGY2 Cardiology Resident WakeMed Health & Hospitals Raleigh,
More information2/11/2016. Managing Polypharmacy: Evidence-based Dissection of Pharmaceuticals. Disclosure. Objectives
Managing Polypharmacy: Evidence-based Dissection of Pharmaceuticals Heather Veeder MD Medical Director VITAS Healthcare San Antonio, TX Adjunct Professor of Medicine University of Texas Health Science
More informationSupplementary Online Content
Supplementary Online Content Melgaard L, Gorst-Rasmussen A, Lane DA, Rasmussen LH, Larsen TB, Lip GYH. Assessment of the CHA 2 DS 2 -VASc score in predicting ischemic stroke, thromboembolism, and death
More information1. What is the preferred method of anticoagulating a high-risk cardiac patient on chronic warfarin therapy. anticoagulation can be continued,
Experts Answering Your Questions Anticoagulating a high-risk cardiac patient 1. What is the preferred method of anticoagulating a high-risk cardiac patient on chronic warfarin therapy for minor surgical
More informationComplicated issues in GI bleeding for internists? Nonthalee Pausawasdi, M.D. Faculty of Medicine Siriraj Hospital
Complicated issues in GI bleeding for internists? Nonthalee Pausawasdi, M.D. Faculty of Medicine Siriraj Hospital Complicated issues in GI bleeding; Survey results from internists Optimal resuscitation
More informationPolypharmacy and Elders. Leslie Baker, Pharm. D., RPh, CGP Sanford Center for Aging
Polypharmacy and Elders Leslie Baker, Pharm. D., RPh, CGP Sanford Center for Aging Prescription Medication Use In Elders 1 13% of the US population is age 65+ Age 65 years 13% Age 65+ account for 34% of
More informationVascular Protection: Preventing Thrombotic Complications of VTE and PAD
Vascular Protection: Preventing Thrombotic Complications of VTE and PAD Thursday, October 11, 2018, 2:00pm ET Guest Speakers: Geoff Barnes, MD Scott Damrauer, MD Moderators: Tracy Minichiello, MD; Sara
More informationAnticoagulation Therapy in LTC
Anticoagulation Therapy in LTC By: Cynthia Leung, RPh, BScPhm, PharmD. Clinical Consultant Pharmacist MediSystem Pharmacy Jun 11, 2013 Agenda Stroke and Bleeding Risk Assessment Review of Oral Anticoagulation
More informationGeriatric vs. Non-Geriatric Anticoagulation Management
Geriatric vs. Non-Geriatric Anticoagulation Management Maija Sanna, MD and Sheila Naghshineh, MD Co-Directors, Anticoagulation Management November 20, 2015 1 Overview Use of anticoagulation in the geriatric
More informationIs there enough evidence for DAPT after endovascular intervention for PAOD?
Is there enough evidence for DAPT after endovascular intervention for PAOD? Prof. I. Baumgartner Head Clinical & Interventional Angiology University Hospital Bern Disclosure Speaker name:...i. Baumgartner...
More informationASPIRIN MISUSE AT HOME ACCORDING TO START AND STOPP IN FRAIL OLDER PERSONS
ASPIRIN MISUSE AT HOME ACCORDING TO START AND STOPP IN FRAIL OLDER PERSONS O. Dalleur 1,4, B. Boland 2,3, A. Spinewine 4-5 1 Pharmacy and 2 Geriatric Medicine, St-Luc university Hospital, 3 Institute of
More informationMedications for Treating Stroke
Medications for Treating Stroke Subject Expert Sonny Kupniewski, PharmD, BCPS Swedish Medical Center Englewood, CO 2 Objectives Medications used to prevent stroke Prevention of strokes in patients with
More informationTRIPLE THERAPY, NOACs with concurrent indication for DAPT. Paul Wright Lead Cardiac Pharmacist The Heart, UCLH NHS Foundation Trust
TRIPLE THERAPY, NOACs with concurrent indication for DAPT Paul Wright Lead Cardiac Pharmacist The Heart, UCLH NHS Foundation Trust Content Why consider triple therapy What we know of triple therapy Current
More informationObjectives. Falling Down on Warfarin Therapy. CHADS 2 Score. CHADS 2 & CHA 2 DS 2 -VASc Score. HAS-BLED Score 04/08/2014. Real World Application
Falling Down on Warfarin Therapy David Andrew Jacob, PharmD Pharmacy Resident 2013-2014 Dayton VA Medical Center Dayton, Ohio Objectives Describe CHADS 2 score and the decision to anticoagulate patients
More informationHypertension Management Controversies in the Elderly Patient
Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No
More informationDEPRESCRIBING. Phil St John CSIM Workshop
DEPRESCRIBING Phil St John CSIM Workshop Conflict of Interest Disclosure Consultant for: none Speaker for: none Received grant/research support from: CIHR, MHRC, Riverview Foundation Received honoraria
More informationAntiplatelet and Anti-Thrombotic Therapy. Ivan Anderson, MD RIHVH Cardiology
Antiplatelet and Anti-Thrombotic Therapy Ivan Anderson, MD RIHVH Cardiology Outline Anti-thrombotic therapy Risk stratification of stroke with atrial fibrillation DVT and PE treatment Pharmacology Anti-platelet
More informationStudy design: multicenter, randomized, open-label trial following a PROBE design
Subgroup Analysis from the RE-DUAL PCI Trial Dual Antithrombotic Therapy with in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Jonas Oldgren, Philippe Gabriel Steg, Stefan
More informationAtrial Fibrillaiton and Heart Failure: Anticoagulation therapy in all cases?
Atrial Fibrillaiton and Heart Failure: Anticoagulation therapy in all cases? Nicolas Lellouche Fédération de Cardiologie Hôpital Henri Mondor Créteil Disclosure Statement of Financial Interest I currently
More informationThe Changing Landscape of Managing Patients with PAD- Update on the Evidence and Practice of Care in Patients with Peripheral Artery Disease
Interventional Cardiology and Cath Labs The Changing Landscape of Managing Patients with PAD- Update on the Evidence and Practice of Care in Patients with Peripheral Artery Disease Manesh R. Patel MD Chief,
More informationDisclosures. Theodore A. Bass MD, FSCAI. The following relationships exist related to this presentation. None
SCAI Fellows Course December 10, 2013 Disclosures Theodore A. Bass MD, FSCAI The following relationships exist related to this presentation None Current Controversies on DAPT in PCI Which drug? When to
More informationClinical and Economic Value of Rivaroxaban in Coronary Artery Disease
CHRISTOPHER B. GRANGER, MD Professor of Medicine Division of Cardiology, Department of Medicine; Director, Cardiac Care Unit Duke University Medical Center, Durham, NC Clinical and Economic Value of Rivaroxaban
More informationStratificazione del rischio, corretto bilancio tra ischemia e bleeding: il beneficio clinico netto
Fibrillazione atriale: rischio tromboembolico, Venezia - 27/28 Novembre 2015 Stratificazione del rischio, corretto bilancio tra ischemia e bleeding: il beneficio clinico netto Antonio Raviele, MD, FESC,
More informationHealth Outcome Prioritization as a Tool for Decision Making Among Older Persons With Multiple Chronic Conditions
Health Outcome Prioritization as a Tool for Decision Making Among Older Persons With Multiple Chronic Conditions Mary Tinetti, M.D. Canadian Geriatrics Society May, 2013 CFPC CoI Templates: Slide 1 Faculty/Presenter
More informationPOLYPHARMACY IN OLDER ADULTS AND BEERS CRITERIA UPDATE
POLYPHARMACY IN OLDER ADULTS AND BEERS CRITERIA UPDATE Jeannie Kim Lee, PharmD, BCPS, CGP Clinical Pharmacy Director College of Pharmacy The University of Arizona Learning Objectives: State the risks of
More informationANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION
ANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION Colin Edwards Auckland Heart Group Waitemata Health June 2015 PFIZER Lecture series Disclosures EPIDEMIOLOGY Atrial fibrillation is the most
More informationWestern University of Health Sciences, College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of
Western University of Health Sciences, College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Topic UAN# Target Audience A
More informationCARDIAC REHABILITATION PROGRAMME:- MEDICATION
CARDIAC REHABILITATION PROGRAMME:- MEDICATION AIM OF THIS SESSION Understand the reasons for taking your medications, Discuss the common side effects associated with these medications - knowing when to
More informationIndividual Therapeutic Selection Of Anti-coagulants And Periprocedural. Miguel Valderrábano, MD
Individual Therapeutic Selection Of Anti-coagulants And Periprocedural Management Miguel Valderrábano, MD Outline Does the patient need anticoagulation? Review of clinical evidence for each anticoagulant
More informationSecondary Preven-on of Thromboembolic Stroke: Clinical Data and Recommenda-ons from the ESC Atrial Fibrilla-on Guideline Update 2012
Secondary Preven-on of Thromboembolic Stroke: Clinical Data and Recommenda-ons from the ESC Atrial Fibrilla-on Guideline Update 2012 Professor Dan Atar Head, Dept. of Cardiology Councillor of the ESC,
More informationDual Antiplatelet Therapy Made Practical
Dual Antiplatelet Therapy Made Practical David Parra, Pharm.D., FCCP, BCPS Clinical Pharmacy Program Manager in Cardiology/Anticoagulation VISN 8 Pharmacy Benefits Management Clinical Associate Professor
More informationStarting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective
Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective Cathy Sila MD George M Humphrey II Professor and Vice Chair of Neurology Director, Comprehensive Stroke Center
More informationOral anti-thrombotic therapy-management in patients requiring endoscopy
Oral anti-thrombotic therapy-management in patients requiring endoscopy Management of anti-thrombotic therapy in patients requiring endoscopy This guideline suggests appropriate management of patients
More informationIS THERE STILL A PLACE FOR VITAMINE K ANTAGONISTS?
IS THERE STILL A PLACE FOR VITAMINE K ANTAGONISTS? J.Y. LE HEUZEY Georges Pompidou Hospital, René Descartes University, Paris H E G P Munich, August 27, 2012 Disclosure Consultant / Conferences / Advisory
More informationFølgende dias er fremlagt ved DCS / DTS Fællesmøde 13. januar 2011 og alle rettigheder tilhører foredragsholderen. Gengivelse må kun foretages ved
. Følgende dias er fremlagt ved DCS / DTS Fællesmøde 13. januar 2011 og alle rettigheder tilhører foredragsholderen. Gengivelse må kun foretages ved tilladelse Antithrombotic therapy in Atrial Fibrillation
More informationNovel Anticoagulants PHYSICIANS UPDATE 2014
Novel Anticoagulants PHYSICIANS UPDATE 2014 Farouk Mookadam MD FRCPC FACC MSc Professor College of Medicine Mayo Consultant Cardiovascular Diseases Medical Director Anticoagulation Clinic Assoc Programme
More information5/2/2016. Outpatient Stroke Management Sheila Smith MD May 5, 2016
Outpatient Stroke Management Sheila Smith MD May 5, 2016 1 Management of Outpatient Stroke Objectives Review blood pressure management post stroke Review antithrombotic therapy Review statin therapy Discuss
More informationDental Management Considerations for Patients on Antithrombotic Therapy
Dental Management Considerations for Patients on Antithrombotic Therapy Warfarin and Antiplatelet Joel J. Napeñas DDS FDSRCS(Ed) Program Director General Practice Residency Program Department of Oral Medicine
More informationDementia and Cognition in Older Adults: Year in Review
Dementia and Cognition in Older Adults: Year in Review 2008 2009 Advances in Internal May June 2009 Bree Johnston, MD MPH Professor of Clinical bree.johnston@ucsf.edu Methodology Clinically important for
More informationUPDATES FROM THE 2018 ANTIPLATELET GUIDELINES
UPDATES FROM THE 2018 ANTIPLATELET GUIDELINES Claudia Bucci BScPhm, PharmD Clinical Coordinator, Cardiovascular Diseases Sunnybrook Health Sciences Centre 21st Annual Contemporary Therapeutic Issues in
More informationAnticoagulants and antiplatelet therapy in the older patient: Choosing wisely
Anticoagulants and antiplatelet therapy in the older patient: Choosing wisely Rajiv Gulati, MD PhD Advances in Cardiac Arrhythmias & Great Innovations in Cardiology Torino, October 2015 2015 MFMER 3477310-1
More informationMedication Reviews within Care Homes. Catherine Armstrong
Medication Reviews within Care Homes Catherine Armstrong What is a Medication Review? A structured, critical examination of a patient s medicines with the objective of reaching an agreement with the patient
More informationBLCS 1-Clinical Overview. Dr. Chris Rauscher Clinical Lead Shared Care Polypharmacy Risk Reduction Initiative
BLCS 1-Clinical Overview Dr. Chris Rauscher Clinical Lead Shared Care Polypharmacy Risk Reduction Initiative Fraser Health Guide To Person-Centered Medication Decisions Factors to Consider When Systematically
More information11/4/2017. but cocaine toxicity is complex: Pro thrombotic effects Progressive atherosclerosis Ventricular remodeling
2 Learning Objectives ATRIUM Fall Patient Safety Webinar Cardiology Mythbusters: Vol 1 Brent N. Reed, PharmD, BCPS AQ Cardiology Associate Professor, University of Maryland School of Pharmacy This presentation
More informationThe randomized study of efficiency and safety of antithrombotic therapy in
.. [ ] 18 150 160 mg/d 2 mg/d INR 2.0 3.0( 75 INR 1.6 2.5) 704 369 335 420 59.7% 63.3 9.9 19 2 24 2.7% 6.0% P =0.03 OR 0.44 95% CI 0.198 0.960 56% 62% 1.8% 4.6% P =0.04 OR 0.38 95% CI 0.147 0.977 52% 10.6%
More informationThe Challenge. Warfarin or Novel Oral Anti-Coagulants in the PCI patient? Anticoagulation/Stroke
Anticoagulation/Stroke Warfarin v new oral anticoagulants post PCI Warfarin or Novel Oral Anti-Coagulants in the PCI patient? Gerry Devlin Chairs: Phillip Matsis & Tony Scott Gerry Devlin Honorary Associate
More informationNational Horizon Scanning Centre. Irbesartan (Aprovel) for prevention of cardiovascular complications in patients with persistent atrial fibrillation
Irbesartan (Aprovel) for prevention of cardiovascular complications in patients with persistent atrial fibrillation August 2008 This technology summary is based on information available at the time of
More informationA new era in the treatment of peripheral artery disease (PAD)?
A new era in the treatment of peripheral artery disease (PAD)? Prof. Dr. Jan Beyer-Westendorf Head of Thrombosis Research, University Hospital Carl Gustav Carus, TU Dresden; Germany Senior Lecturer Thrombosis
More informationStroke Prevention & Atrial Fibrillation. Susanne Christie Arrhythmia Nurse Specialist 24 th September 2015
Stroke Prevention & Atrial Fibrillation Susanne Christie Arrhythmia Nurse Specialist 24 th September 2015 Learning Outcomes What is Atrial Fibrillation? Why is Atrial Fibrillation important? What causes
More informationManagement of Patients with Atrial Fibrillation and Stents: Is Three Drugs Too Many?
Management of Patients with Atrial Fibrillation and Stents: Is Three Drugs Too Many? Neal S. Kleiman, MD Houston Methodist DeBakey Heart and Vascular Center, Houston, TX Some Things Are Really Clear 2013
More informationConflicts of Interest: None. Aspirin, primary prevention and USPSTF. Primary prevention of ASCVD is important
Aspirin, primary prevention and USPSTF Presented by: Craig Williams, PharmD., BCPS., FNLA; February 2017 Conflicts of Interest: None Primary prevention of ASCVD is important Myocardial Infarction Incidence
More informationProstate Biopsy Alerts
Prostate Biopsy Alerts Saskatchewan Prostate Assessment Pathway Guidelines for the Primary Care Provider for Patient Preparation and the Management of Medications and Complications September 2016 Table
More informationWarfarin Management-Review
Warfarin Management-Review December 18, 2012 Elaine M. Hylek, MD, MPH Director, Thrombosis Clinic and Anticoagulation Service Boston University Medical Center Areas for Discussion Implications of time
More informationAnti-platelet therapies and dual inhibition in practice
Anti-platelet therapies and dual inhibition in practice Therapeutics; Sept. 25 th 2007 Craig Williams, Pharm.D. Associate Professor of Pharmacy Objectives 1. Understand the pharmacology of thienopyridine
More informationStroke secondary prevention. Gill Cluckie Stroke Nurse Consultant St. George s Hospital
Stroke secondary prevention Gill Cluckie Stroke Nurse Consultant St. George s Hospital Stroke recurrence The risk of recurrent stroke is greatest after first stroke 2 3% of survivors of a first stroke
More informationThe Poor Long-Term Candidate for Warfarin: NOAC or Left Atrial Appendage Closure?
The Poor Long-Term Candidate for Warfarin: NOAC or Left Atrial Appendage Closure? Suneet Mittal, MD, FACC, FHRS Director, Electrophysiology Laboratory Valley Health System Ridgewood, NJ and New York, NY
More information325 mg aspirin and plavix
325 mg aspirin and plavix 12-3-2006 Background Dual antiplatelet therapy with clopidogrel plus low-dose aspirin has not been studied in a broad population of patients at high risk for. Compare Aspirin
More information