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Effects of Antithrombotic and Results of Drug Screening
Published in Josef Hladovec, Antithrombotic Drugs in Thrombosis Models, 2020
The story of acetylsalicylic acid began to unfold a long time ago. Since its introduction to the market under the name Aspirin in 1899 by Bayer, it has been one of the most effective nonsteroid anti-inflammatory drugs (NSAID), also classified by pharmacologists as analgesics-antipyretics. Its range of indications is fairly wide and the drug was for many years and still is one prescribed and taken in the largest quantities. Its recently introduced additional use as an antithrombotic started after World War II. The idea originated from some clinicians, e.g., Gibson,1 who came to believe, without a particularly rational background, that the drug might be effective as an antithrombotic. Its weak effects as antivitamin K and on the prolongation of bleeding are by no means impressive. Gibson treated a large number of patients with alleged success, unfortunately not satisfying the requirements of a controlled clinical trial. In fact, these criteria were, at that time, not yet well defined. At the same time, platelets and their functions came into the focus of increased attention, at first as various adhesivity tests. Bounameaux2 showed the effectiveness of salicylate in an ex vivo study already in 1954. After the introduction of the photometric aggregation method by Born in 1962,3 the effectiveness of ASA in this test was simultaneously demonstrated in several laboratories in 1968.4–7 The first relatively well-controlled clinical trials were published in 1974.8 In 1968, the effectiveness of ASA was also demonstrated in an animal model.7 In 1971 Vane8 demonstrated that the drug inhibits tissue cyclo-oxygenase while Smith and Willis9 described the same effect in platelets. It was Moncada et al. who in 197910 presented an attempt at a unified concept of aspirin action based on the inhibition of eicosanoid production. Nevertheless, despite a wide acceptance,11, 12 this concept is probably not the only explanation of aspirin activity, and possibly not even the most plausible one. The mechanism of antithrombotic activity of ASA remains, in general, insufficiently clarified. Despite this shortcoming, ASA is now the most widely acknowledged platelet-inhibiting drug used on a large scale in many countries and in a number of both acute and chronic clinical situations. Thus, its always broad indications have become still significantly broader making ASA one of the most successful drugs ever invented. Of course, there exist various side effects, but in view of the massive use and abuse, this is not surprising and does not belittle its value as a relatively nontoxic drug.
General practitioners' attitude towards cooperation with other health professionals in managing patients with multimorbidity and polypharmacy: A cross-sectional study
Published in European Journal of General Practice, 2022
Hélène Carrier, Anna Zaytseva, Aurélie Bocquier, Patrick Villani, Martin Fortin, Pierre Verger
As a result, health policies in several countries encourage interprofessional cooperation and multi-professional practices (e.g. multidisciplinary or multi-professional group practices and healthcare networks) [11,12]. In France, primary care is mainly provided by independent professionals in private practice. Most often, these health professionals (GPs, nurses, physiotherapists, pharmacists, etc.) are installed separately, financially autonomous and cooperate in the form of informal networks. Over the last fifteen years, the title of ‘team health action’ nurses has been created to participate in the follow-up of patients with chronic diseases, alongside GPs with whom they sign a collaboration protocol. The primary role of these nurses is the therapeutic education of patients. In recent years, several medical acts have been authorised for pharmacists: vaccination, prescription review, monitoring of anti-vitamin K treatments, for example. Several qualitative studies have examined the experiences and perceptions of health professionals regarding interprofessional cooperation. In these studies, several factors for optimal management of patients with polypharmacy have been proposed: interprofessional cooperation, including with pharmacists, a partnership relationship with specialists, with greater transparency and equality [13,14]. However, little is known about how GPs cooperate with other health professionals (specialist doctors and non-medical professionals such as pharmacists, nurses, physiotherapists etc) and to what extent this cooperation takes place in the management of patients with multimorbidity and polypharmacy.
Safety considerations selecting antiseizure medications for the treatment of individuals with Dravet syndrome
Published in Expert Opinion on Drug Safety, 2021
Rima Nabbout, N Chemaly, C Chiron, M. Kuchenbuch
STP mainly inhibits CYP2C19, CYP3A4, and CYP2D6, resulting after STP introduction in individuals with Dravet syndrome, of an increase in plasma level of CLB or nCLB (1.8- and 5.5-fold), VPA (1.2-fold), TPM, ETS, 7-OH-CBD, and FFA (1.7-fold) with potential major adverse events, and a decrease of OH-nCLB, 7-OH-CBD and nFFA (0.6-fold) [73–76]. For example, to account for these interactions, when adding STP to a regimen of ASM containing FFA, it is recommended that the dosage of FFA be decreased by half [75]. The combination of STP with theophylline and anti-vitamin K are contraindicated and some other interactions must be considered as, for example, macrolides, beta-blockers, lidocaine, hypnotic, anti-depressants, omeprazole, and morphinics due to the impact of STP on metabolism of drugs involving CYP2C19, CYP3A4, and CYP2D6. MA of STP explicitly specified the use of STP as an add-on of CLB in Dravet syndrome, and also VPA in the EU.
Duration of anticoagulant therapy in pediatric venous thromboembolism: Current approaches and updates from randomized controlled trials
Published in Expert Review of Hematology, 2018
Cristina Tarango, Sam Schulman, Marisol Betensky, Neil A Goldenberg
Another randomized open-label study, the Durée Optimale du Traitement Anti-Vitamin K (DOTAVK) trial, was the first randomized trial to compare 3 versus 6 months of oral anticoagulant therapy in proximal DVT in adults [22]. This trial also investigated duration of therapy in distal DVT, via separate randomization of these patients to 6 weeks versus 3 months of oral anticoagulation. The DOTAVK trial enrolled 736 patients, and unfortunately was closed early due to slow accrual. Although underpowered to demonstrate non-inferiority, no difference in recurrent VTE or major bleeding risks were detected between the two duration-of-therapy arms in proximal DVT, by both the intention-to-treat and the per-protocol analysis. The overall VTE recurrence rate was 8.4%. Similar to the DURAC trial, nearly half of the study population had either an unprovoked index VTE or chronic VTE risk factors.