For the acute treatment of venous thromboembolism, the direct oral anticoagulants (DOACs) have increasingly replaced injectable anticoagulant therapy followed by warfarin. For patients with an unprovoked deep vein thrombosis or pulmonary embolism who may benefit from long-term extended prophylaxis for the secondary prevention of VTE, the choice is less clear. Should a DOAC be used? If so, which one and what's the best dose? What about low-dose aspirin? Is extended therapy needed at all? The EINSTEIN CHOICE study adds important new insights to the growing body of literature.
More than 15 million Americans have coronary heart disease and most should be taking aspirin daily. Given aspirin’s ubiquity in cardiovascular medicine and patients’ pill boxes, it is shocking that there are still so many unanswered questions about aspirin use. Which dose and dosage forms should be prescribed? How common is aspirin resistance? What is the relationship between platelet inhibition and clinical outcomes?
Many patients with atrial fibrillation (AF) received triple antithrombotic therapy after undergoing a percutaneous coronary intervention (PCI) and receiving cardiac stent. Triple therapy consists of warfarin plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and low-dose aspirin. But is triple therapy the best approach? This practice, while widely employed, is not entirely evidence-based. Moreover, the effectiveness and safety of the direct oral anticoagulants (DOACs) in this patient population is unknown.
Could automated, web-based cognitive behavioral therapy (CBT) replace flesh-and-blood healthcare practitioners? Can computers deliver healthcare at lower cost and similar quality to face-to-face interactions with humans? Several web-based CBT programs have been developed and are now being marketed directly to consumers. But do they actually work?
Hypertension affects more than 70% of patients with type 2 diabetes mellitus and further increases the risk of cardiovascular disease in this high-risk population.1 While renin angiotensin system (RAS) blockers are clearly indicated in patients with heart failure, chronic kidney disease with proteinuria, and coronary artery disease (CAD), experts have come to different conclusions regarding their role as initial antihypertensive therapy for patients with diabetes.
About 5 million Americans are currently living with heart failure (HF) and an astounding 24-42% also suffer from depression. One meta-analysis found a greater than 2-fold risk of death in patients with HF and comorbid depression. Depressed patients with HF are more likely to be hospitalized, seek care from emergency rooms, and rack up big bills. Not surprisingly, patients with HF and depression have a much lower quality of life when compared to HF patients without depression. Clearly, this is BIG problem. But can we do anything about it?
Critically evaluating the primary literature and applying the information to patient care is vital to ensuring optimal patient outcomes. Unfortunately, the foundational knowledge and skills that most of us acquire during our formal education and post-graduate training programs are unlikely to fully prepare us for the challenges and intricacies of interpreting the evolving methods used in clinical drug studies today. Like the development of any skill, it requires practice and refinement over time. In this TOP TEN list, we reflect on some important concepts that can get overlooked or misinterpreted.
Pharmacotherapy for diabetes management has expanded in recent years with several new drug classes. Current guidelines recommend several options for patients who have not reached their goal A1c on metformin monotherapy including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or basal insulin. However, if basal insulin is chosen as the first add-on treatment with metformin, the post-prandial blood glucose (PPG) often will remain elevated. A combination product that includes both a basal insulin plus a GLP-1 RA has the potential to addresses both fasting blood glucose and PPG … and perhaps has some other advantages over using either product alone.
Colorectal cancer (CRC) is the second most common cause of cancer-related mortality in the United States. Screening is imperative because the early stages of CRC are often asymptomatic.Colonoscopy is an effective and widely employed screening option for CRC. Suboptimal bowel preparation is a problem in more than 20% of colonoscopy procedures, which reduces adenoma detection rates (ADR). Day-before, split-dose, and same-day regimens are options for colon cleansing prior to a colonoscopy. Is one better than another in terms of tolerability and colorectal cancer detection?
Children are often given liquid dosage forms for both prescription and over-the-counter medicines. Several studies have shown that caregivers unintentionally put children at risk by inaccurately measuring the dose of liquid medications. In 2015, the American Academy of Pediatrics (AAP) adopted a policy statement which recommends exclusively using milliliters for dosing instructions to prevent dosing errors. Our guest today critically examines a recent study that examined labeling and dosing tools that may contribute to medication errors.