The heart
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
The congestive effects of cardiomyopathy on the pulmonary and systemic circulation may be relieved somewhat by the use of diuretic drugs and with salt and water restriction. Bed rest can reduce workload on the heart, as can vasodilator drugs that cause venous and arterial dilation. Positive inotropes such as digitalis glycosides may be used in dilated cardiomyopathy to enhance contractile function of the heart muscle. Anticoagulant drugs can also be employed to prevent blood clots from forming in pooled blood. In hypertrophic cardiomyopathy, β blockers may be useful to slow heart rate and allow the ventricles a greater time for filling. Prevention of arrhythmias is also important in hypertrophic cardiomyopathy. Surgical removal of a portion of the hypertrophic ventricles may also be carried out to improve overall cardiac function.
Venous Thromboembolism in Pregnancy
Sanjeewa Padumadasa, Malik Goonewardene in Obstetric Emergencies, 2021
The aims of anticoagulant therapy are to prevent the clot from propagating and to prevent the formation of new clots. When there is a high suspicion of VTE, anticoagulant treatment should be commenced, unless there is a strong contraindication to its use, and continued for one week. This must be done even if the initial duplex ultrasound and V/Q scan or CTPA are negative, at which point PE should definitely be excluded by appropriate investigations. When there is low suspicion of DVT but no suspicion of PE, anticoagulant therapy can be discontinued if the duplex ultrasound is negative. However, duplex ultrasound should be repeated on days 3 and 7 if clinical suspicion of DVT remains high. Anticoagulant treatment should be recommenced if the repeat duplex ultrasound confirms the diagnosis of DVT.
Patent foramen ovale
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček in Congenital Heart Disease in Adults, 2008
Antiaggregation therapy is preferred in elderly patients, with concomitant coronary artery disease, if a cause of CVE/TIA other than paradoxical embolism is likely, and when anticoagulation therapy is contraindicated. Anticoagulation therapy is indicated in concomitant thrombophilic states, deep vein thrombosis, pulmonary embolism, and atrial fibrillation. Surgical management of PFO is currently losing ground. It is indicated in serious complications of catheter-based closure if long-term anticoagulation and antiaggregation therapy is contraindicated; or if preferred by the patient as an alternative to transcatheter closure following drug therapy failure. It may be a method of choice for patients with a metal allergy. Thoracoscopic surgical closure is available in some centers.
Unilateral nonhaemorrhagic adrenal infarction as a cause of abdominal pain during pregnancy
Published in Gynecological Endocrinology, 2019
F. Chasseloup, N. Bourcigaux, S. Christin-Maitre
Unilateral NHAI occurs usually during the third trimester of pregnancy. Clinical presentation is nonspecific with mostly right side intense abdominal pain mimicking labor which makes diagnosis a real challenge [22]. Imaging, especially using MRI criteria, is the best way to confirm diagnosis [3]. Treatment with anticoagulation therapy should be discussed. Because this situation could evolve either towards revascularization or adrenal atrophy, a follow up CT scan for these patients should be considered. As a result of the unilateral nature of adrenal infarction, no adrenal insufficiency is noted. Importantly, precautions need to be taken during a next pregnancy with a thrombophilia workup and preventive anticoagulation treatment as the risk of a contralateral event is unknown. The prevalence of NHAI is probably underestimated and obstetricians and midwives should be aware of such a diagnosis when being confronted with severe resistant abdominal pains.
Real-world comparison of direct-acting oral anticoagulants and vitamin K antagonists in chronic kidney disease: a systematic review and meta-analysis
Published in Expert Review of Hematology, 2021
Rongfang Xu, Fan Wu, Jiarong Lan, Peixin Duan
Where indicated, anticoagulation therapy is an essential intervention for preventing adverse cardiovascular or cerebrovascular events. Among CKD patients requiring anticoagulation, vitamin K antagonists (VKA) like warfarin have been in clinical use for several years [9]. However, in recent times, there has been a gradual shift and widespread adoption of direct-acting oral anticoagulants (DOAC) like apixaban, rivaroxaban, and dabigatran for preventing thromboembolism [10,11]. Since DOAC are predominantly excreted by the kidneys, their safety and efficacy have not been tested in large-scale randomized controlled trials (RCTs) wherein high-risk CKD patients were excluded [12,13]. Post-hoc analysis of such trials based on renal function has suggested that DOAC may have a favorable profile in patients with mild-moderate CKD as compared to warfarin [14]. However, to date, no clear clinical guidelines exist on the type of anticoagulant to be used for CKD patients. Despite limited efficacy and safety data, the US Food and Drug Administration (FDA) has approved reduced doses of apixaban, edoxaban, and rivaroxaban in patients with severe CKD. Low-dose dabigatran (75 mg twice daily) has also been approved based on pharmacokinetic data for CKD patients [8].
Pharmacokinetics of anticoagulants apixaban, dabigatran, edoxaban and rivaroxaban in elderly Japanese patients with atrial fibrillation treated in one general hospital
Published in Xenobiotica, 2019
Miho Yamazaki-Nishioka, Minoru Kogiku, Masayuki Noda, Sumio Endo, Mitsuru Takekawa, Hirohisa Kishi, Miki Ota, Yuki Notsu, Makiko Shimizu, Hiroshi Yamazaki
Anticoagulant therapy is commonly used for the prevention and treatment of venous thromboembolism and the prevention of stroke in patients with atrial fibrillation (Rose & Bar, 2018). The basis of thrombosis treatment is anticoagulation. Anticoagulants are drugs that prevent and treat blood clots and reduce the risk of blood clots breaking off and travelling to vital organs. Different types of oral anticoagulants are widely used clinically (Adcock & Gosselin, 2015): Warfarin is a vitamin K antagonist; dabigatran is a thrombin inhibitor; and apixaban, rivaroxaban and edoxaban are direct inhibitors of blood coagulation factor Xa (Graff & Harder, 2013). The traditional drug warfarin targets the vitamin K epoxide reductase complex subunit 1. Warfarin doses are set individually by monitoring the prothrombin time/international normalized ratios or by genotyping drug metabolizing enzymes (Miyagata et al., 2011).
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