For over two decades LMWHs have been routinely used to provide therapeutic coverage in patients who must temporarily stop warfarin. Current guidelines suggest using injectable anticoagulants during warfarin interruption (aka bridging) in patients with atrial fibrillation based on patients’ risk of arterial thrombosis. Using the CHADS2 score to assess risk, the guidelines recommend (grade 2C) bridge therapy if the CHADS2 score is 5 or higher and not bridging if the CHADS2 score is 2 or lower. But what about patients with a CHADS2 score of 3 or 4?
Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25, 50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for patients with diabetes requiring insulin continues to expand. Current guidelines for glycemic management of patients with type 2 diabetes provide specific recommendations for the initiation of insulin therapy, but not insulin intensification. The recently published LanScape study provides a foundation for making evidence-based clinical decisions.