Tag Archives: dabigatran

Introduction Atrial fibrillation (AF) is a common arrhythmia affecting approximately 1% of the general population, this rises to 18% in those aged 85 years and above.1 The most effective method for correcting persistent AF is direct current cardioversion (DCCV). However, DCCV is associated with an increased risk of thromboembolic events.2 Anticoagulation with warfarin reduces the risk of thromboembolism from approximately 6% to less than 1%.3 The current recommendations advise therapeutic anticoagulation for at least three weeks prior to, and four weeks after cardioversion.4 A nurse-led elective DCCV service at Raigmore Hospital was establish

The study, published in Circulation on June 14 (Circulation 2012; 126:343–8.  http://dx.doi.org/10.1161/CIRCULATIONAHA.111.090464), reported bleeding rates in RE-LY from seven days before until 30 days following invasive procedures in a total of 4,591 patients. Procedures included pacemaker/defibrillator insertion, dental procedures, diagnostic procedures, cataract removal, colonoscopy, and joint replacement. Among patients assigned to dabigatran, the last dose of study drug was given an average of 49 hours prior to the procedure, compared with 114 hours in patients receiving warfarin. Bridging anticoagulation with heparin was given in 28%

This topic was also included in the UK MHRA’s December Drug Safety Update, which gave the following new advice: Do not start dabigatran in any patient with severe renal impairment (creatinine clearance <30 mL/min) Assess renal function: in all patients before starting dabigatran;  when a decline in renal function is suspected during treatment (e.g. hypovolaemia, dehydration, or with some co-medications); at least annually in patients older than 75 years; and at least annually in patients with renal impairment. Check for signs of bleeding or anaemia and stop treatment if severe bleeding occurs. In the US, the Food and Drug Administrati

UK cholesterol awareness low Millions of people in the UK hold incorrect beliefs about the risks of cardiovascular disease (CVD), according to HEART UK research. The research, which tested 1,177 people on their knowledge and concerns about high cholesterol, revealed that more than 40% of respondents wrongly thought that raised cholesterol resulted from drinking too much, while almost 60% did not know that the condition can be inherited. Almost half the population have never had a cholesterol check and only 2% of those surveyed named high cholesterol as their biggest health concern. The top health worry for people was cancer, even though CVD i

SAPIEN valve positive results Clinicians have achieved successful one-year outcomes in high-risk or inoperable patients undergoing transcatheter aortic valve replacement during the first two years since release of the valve (Sapien®, Edwards) commercially, according to results presented at the Euro PCR 2001 meeting in Paris, France. Despite high predicted mortality and multiple co-morbidities in many of these patients, survival at one year was 76% in the 1,038 patients treated as part of Cohort I (first year of commercialisation), and 77% in the 1,269 patients treated as part of Cohort II (second year of commercialisation).  Since November

Controversial salt paper published A new European study has caused controversy by suggesting that lowering salt intake may not be beneficial. The study, published recently in JAMA (May 4th 2011 issue), was conducted by a team from the University of Leuven, Belgium. They followed 3,681 participants who were free of cardiovascular disease at baseline for a median of 7.9 years, and found an inverse relationship between cardiovascular deaths and 24-hour sodium excretion (which correlates to salt intake), although systolic blood pressure was higher with higher salt intake. But an editorial in the Lancet (May 12th 2011 issue) criticises the study,

ARBITER 6: niacin superior to ezetimibe for slowing atherosclerosis Use of extended-release niacin resulted in a significant benefit on atherosclerosis compared with ezetimibe in patients already taking statins in the ARBITER 6-HALTS trial. The trial, presented at the meeting by Dr Allen Taylor (Medstar Research Institute, Washington DC, US), compared two distinct lipid-modifying strategies in patients with known vascular disease already on statins who had LDL-cholesterol levels <100 mg/dL (2.56 mmol/L) and moderately low HDL-cholesterol levels (<50 mg/dL [1.28 mmol/L]). Among the 363 patients enrolled in the study, half were randomised