Tag Archives: dose

Introduction Warfarin is an anticoagulant commonly used in atrial fibrillation, venous thromboembolism, prosthetic cardiac valve replacement and postoperative atrial fibrillation.1 Warfarin is usually discontinued prior to cardiac surgery and subsequently re-initiated postoperatively to achieve the target therapeutic international normalised ratio (INR).2 At the cardiac surgery unit of St. Paul’s Hospital, it has been observed that the warfarin dosage needed to achieve therapeutic anticoagulation is often lower post-cardiac surgery, compared with the patient’s warfarin dose prior to cardiac surgery. Serious complications, such as postoper

Counting the cost of acute heart failure In the first keynote lecture, Professor John McMurray (BHF Cardiovascular Research Centre, Glasgow) began by addressing the definition of acute heart failure (HF). He felt the term ‘acute’ was unhelpful, as it can be applied to a broad spectrum of clinical presentation, from the rapid onset of acute pulmonary oedema, to the subacute deterioration in chronic HF symptoms (predominantly peripheral oedema) that culminates in hospitalisation. Accordingly, the new 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) HF guidelines refer to ‘the hospitalised patient’,

Introduction Drugs that block the renin–angiotensin–aldosterone system, the angiotensin-converting enzyme inhibitors (ACEIs) and the angiotensin-receptor blockers (ARBs), have been shown to be effective in the management of hypertension, heart failure and several forms of renal disease including diabetic nephropathy. For this reason, the use of these agents is likely to increase steadily in the coming years. It is also clear from many of the randomised controlled trials that there is a dose-response curve for these agents, with higher doses being more effective.1-6 In the course of our clinical practice in acute general medicine, we obser

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