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Newer antiplatelet agents in acute coronary syndrome

Dual antiplatelet therapy comprising aspirin and a purinergic P2Y12 receptor inhibitor has long been the standard of care in patients with acute coronary syndrome (ACS). Clopidogrel is the most commonly used P2Y12 inhibitor,1 but its usefulness has been questioned, with 25-30% of patients achieving <25% inhibition of platelet activity. Moreover, onset (4-6 hours, even after a loading dose) and offset (5-7 days, the lifetime of platelets) of its activity are relatively slow. This slow offset is due to its irreversible binding to the P2Y12 receptor and may assume importance in patients with bleeding complications or in those requiring urgent surgical intervention. Slow onset is disadvantageous in patients with ACS, owing to the potential for propagation of thrombus in the interval until P2Y12 inhibition occurs.  
feeds.bmj.com
over 4 years ago
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Newer antiplatelet agents in acute coronary syndrome

Dual antiplatelet therapy comprising aspirin and a purinergic P2Y12 receptor inhibitor has long been the standard of care in patients with acute coronary syndrome (ACS). Clopidogrel is the most commonly used P2Y12 inhibitor,1 but its usefulness has been questioned, with 25-30% of patients achieving <25% inhibition of platelet activity. Moreover, onset (4-6 hours, even after a loading dose) and offset (5-7 days, the lifetime of platelets) of its activity are relatively slow. This slow offset is due to its irreversible binding to the P2Y12 receptor and may assume importance in patients with bleeding complications or in those requiring urgent surgical intervention. Slow onset is disadvantageous in patients with ACS, owing to the potential for propagation of thrombus in the interval until P2Y12 inhibition occurs.  
feeds.bmj.com
over 4 years ago
Preview
0
0

Newer antiplatelet agents in acute coronary syndrome

Dual antiplatelet therapy comprising aspirin and a purinergic P2Y12 receptor inhibitor has long been the standard of care in patients with acute coronary syndrome (ACS). Clopidogrel is the most commonly used P2Y12 inhibitor,1 but its usefulness has been questioned, with 25-30% of patients achieving <25% inhibition of platelet activity. Moreover, onset (4-6 hours, even after a loading dose) and offset (5-7 days, the lifetime of platelets) of its activity are relatively slow. This slow offset is due to its irreversible binding to the P2Y12 receptor and may assume importance in patients with bleeding complications or in those requiring urgent surgical intervention. Slow onset is disadvantageous in patients with ACS, owing to the potential for propagation of thrombus in the interval until P2Y12 inhibition occurs.  
feeds.bmj.com
over 4 years ago
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Fibrin Sealant Patch Provides Better Hemostasis During Liver Resection

Fibrin sealant patches (FSP) provide better secondary control of local bleeding than cellulose patches in patients undergoing liver resection, researchers report.  
medscape.com
over 4 years ago
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Misoprostol - Wikipedia, the free encyclopedia

Misoprostol, sold under the brandname Cytotec among others, is a medication used to start labor, cause an abortion, prevent and treat stomach ulcers, and treat postpartum bleeding due to poor contraction of the uterus.[1] For abortions it is often used with mifepristone or methotrexate.[2] By itself effectiveness for this purpose is between 66% and 90%.[3] It is taken either by mouth, under the tongue, or placed in the vagina.[2][4]  
en.wikipedia.org
over 4 years ago
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Less Bleeding on Rivaroxaban for AF if Fewer Concomitant Meds

Taking five or more meds is common in patients with AF, but for those taking fewer than that, the risk of bleeding was lower with rivaroxaban than with warfarin, in a new analysis of ROCKET-AF.  
medscape.com
over 4 years ago
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ORBIT: A Simple Bedside Score to Assess Bleeding Risk in AF

The authors present a novel bleeding risk score using routinely available clinical information to predict major bleeding in patients with atrial fibrillation.  
medscape.com
over 4 years ago
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VTE Risk After Receiving PCC for Intracranial Hemorrhage

Prothrombin complex concentrates are commonly used for the reversal of coagulopathy in warfarin-associated intracranial hemorrhage, but there may be a greater risk for VTE in some patients.  
medscape.com
over 4 years ago
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Decisions on restarting anticoagulation should be made earlier after rebleeding

Staerk and colleagues’ paper provides support for the important, perhaps underused, practice of reintroducing anticoagulation after a gastrointestinal haemorrhage.1 Some aspects of the paper need to be put into context. The data on antiplatelet agents for atrial fibrillation have little relevance to current practice because the management and epidemiology of gastrointestinal bleeding has changed over the course of the study (1996-2012). Improvements in endoscopic and medical management have …  
feeds.bmj.com
over 4 years ago
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0

Decisions on restarting anticoagulation should be made earlier after rebleeding

Staerk and colleagues’ paper provides support for the important, perhaps underused, practice of reintroducing anticoagulation after a gastrointestinal haemorrhage.1 Some aspects of the paper need to be put into context. The data on antiplatelet agents for atrial fibrillation have little relevance to current practice because the management and epidemiology of gastrointestinal bleeding has changed over the course of the study (1996-2012). Improvements in endoscopic and medical management have …  
feeds.bmj.com
over 4 years ago
Preview
0
0

Decisions on restarting anticoagulation should be made earlier after rebleeding

Staerk and colleagues’ paper provides support for the important, perhaps underused, practice of reintroducing anticoagulation after a gastrointestinal haemorrhage.1 Some aspects of the paper need to be put into context. The data on antiplatelet agents for atrial fibrillation have little relevance to current practice because the management and epidemiology of gastrointestinal bleeding has changed over the course of the study (1996-2012). Improvements in endoscopic and medical management have …  
feeds.bmj.com
over 4 years ago
Preview
0
1

Decisions on restarting anticoagulation should be made earlier after rebleeding

Staerk and colleagues’ paper provides support for the important, perhaps underused, practice of reintroducing anticoagulation after a gastrointestinal haemorrhage.1 Some aspects of the paper need to be put into context. The data on antiplatelet agents for atrial fibrillation have little relevance to current practice because the management and epidemiology of gastrointestinal bleeding has changed over the course of the study (1996-2012). Improvements in endoscopic and medical management have …  
feeds.bmj.com
over 4 years ago
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Upper Gastrointestinal Hemorrhage: An Update

What are the latest evidence-based recommendations for the management of acute upper GI hemorrhage?  
medscape.com
over 4 years ago
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Briefs: Neither pyogenic nor granuloma

A concerned mom presents with her daughter who has the following lesion on her left cheek that has enlarged over the past month and today wouldn’t stop bleeding at daycare. It started as a red dot a few months back and has grown steadily.  
pemcincinnati.com
over 4 years ago
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Antenatal administration of corticosteroids for women at risk of preterm birth

The administration of certain corticosteroids to women at risk of preterm birth causes a considerable reduction in the risks of complications of prematurity such as respiratory distress syndrome, intraventricular haemorrhage and perinatal death. Corticosteroid therapy should be incorporated into comprehensive maternal health care services and official guidelines for maternity care.  
apps.who.int
over 4 years ago
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The Insurance Policy Against Bleeding: Status of Antidotes for NOACs CME

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.  
medscape.org
over 4 years ago
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Clinical Guideline on Hematuria Released by ACP

The American College of Physicians has issued high-value care advice for evaluating hematuria as a sign of cancer.  
medscape.com
over 4 years ago
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6

EVARREST: Patch to Stop Difficult Bleeding During Surgery (Interview) |

Ethicon is a company that is a part of the Johnson and Johnson family of companies. Their main focus is developing new technologies to advance innovation i  
medgadget.com
over 4 years ago
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Critical Care

Heparin-induced thrombocytopenia (HIT) type II is a highly morbid and potentially life-threatening condition with limited treatment options in older patients at high risk of bleeding who develop acute kidney injury (AKI). The recent study by Tardy-Poncet et al. [1] showing that argatroban may be a safe and valid therapeutic option in this patient population is therefore of utmost clinical importance. However, when discussing other alternative therapies for HIT type II, the authors did not mention recent experience with fondaparinux, a selective synthetic antithrombin-mediated inhibitor of coagulation factor Xa [2].  
ccforum.biomedcentral.com
over 4 years ago
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R.E.B.E.L. EM - Epistaxis Myths Part I - Do Patients with Epistaxis Managed by Nasal Packing Require Prophylactic Antibiotics? - emdocs

Traditional teaching argues that patients with nasal packs should be given prophylactic antibiotics to prevent serious infectious complications. Is there evidence to support this dogma? Read this post as Dr. Swaminathan discusses the evidence to bust this myth.  
emdocs.net
over 4 years ago