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A Cause for a PAUSE: Evaluating a Standardized Perioperative DOAC Management Protocol

A Cause for a PAUSE: Evaluating a Standardized Perioperative DOAC Management Protocol

January 31, 2020

One in six patients with atrial fibrillation (AF), or an estimated six million patients worldwide, will require perioperative anticoagulant management this year.  Ambulatory care pharmacists commonly face the scenario where a patient taking a direct oral anticoagulant (DOAC) for AF requires an elective surgery or procedure. Best practices for periprocedural management of DOACs are unclear and current guidelines differ in their recommended approaches. Having a simple, systematic periprocedural DOAC management protocol would be helpful. But would a straightforward protocol that is easily understood by clinicians and patients be safe and effective? The PAUSE study investigators attempt to establish the standard of care.

Guest Authors:  Maggie Faraj, PharmD and Candice Garwood, PharmD, BCPS, BCACP

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Who CARES? Getting to the Heart of Allopurinol and Febuxostat CV Outcomes

Who CARES? Getting to the Heart of Allopurinol and Febuxostat CV Outcomes

January 17, 2020

Should we target uric acid levels when working to reduce cardiovascular risk? Cardiovascular (CV) disease remains the leading cause of death with many contributing risk factors, including hyperuricemia. Evidence suggests an elevation in uric acid levels is associated with and can lead to worse outcomes for individuals with CV disease and heart failure.  The Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARES) trial was conducted to evaluate whether febuxostat was noninferior to allopurinol with regard to CV events in patients with gout and CV disease.

Guest Authors:  Sophia Dietrich, PharmD and Michael W. Nagy, PharmD, BCACP

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Up in Flames: Antiplatelet Therapy in Patients with Stable Ischemic Heart Disease Receiving Anticoagulation for A-fib

Up in Flames: Antiplatelet Therapy in Patients with Stable Ischemic Heart Disease Receiving Anticoagulation for A-fib

January 3, 2020

Antiplatelet therapy is a mainstay treatment for the prevention of recurrent cardiovascular events in patients with stable coronary artery disease (CAD). Anticoagulation therapy is the cornerstone of therapy for most patients with atrial fibrillation (AF). AF and CAD are frequent comorbid conditions, occurring in 20-30% of patients with stable CAD. Unfortunately, combining antiplatelet and anticoagulation therapy increases the risk of major bleeding over 50% compared to anticoagulation alone. Recent real-world observational data suggest that direct oral anticoagulation (DOACs) therapy can reduce cardiovascular event rates. This begs the question: In patients with stable CAD and AF, is combination therapy necessary or is anticoagulation monotherapy sufficient?  The AFIRE study attempted to address this important clinical question.

Guest Authors: Alina Kukin, PharmD and Zachary R. Noel, PharmD, BCCP

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Is Dapagliflozin aDAPtAble to Treating HFrEF in Patients Without Diabetes?

Is Dapagliflozin aDAPtAble to Treating HFrEF in Patients Without Diabetes?

December 13, 2019

Heart failure with reduced ejection fraction (HFrEF) is associated with significant morbidity and mortality. Current guidelines recommend a renin-angiotensin inhibitor, beta-blocker, and aldosterone antagonist to reduce morbidity and mortality in these patients. Despite the use of multiple drug classes, 5-year mortality rates hover near 50% in patients with heart failure (HF). Despite the numerous medications available, mortality and the risk of HF hospitalizations remains high. Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) have been shown to reduce HF hospitalizations in patients with diabetes. Could this medication class be useful for HF treatment even in patients without diabetes?

Guest Authors:  John Andraos, PharmD; Alexa Zeiger, PharmD; and Michael S. Kelly, PharmD, BCACP

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Are Older Adults with Heart Failure Self-Care Aware?

Are Older Adults with Heart Failure Self-Care Aware?

December 6, 2019

Heart failure (HF) affects at least 5.7 million people in the United States alone and requires a strict self-care regimen to avoid hospitalizations. Patients with HF have high readmission rates, high medical costs, and many experience a poor quality of life. But what if patients with HF do not understand or are not capable of carrying out the recommended HF “self-care regimen”? Subjective questionnaires are often used to assess HF symptoms and self-care behaviors but may not accurately depict a patient’s functional capabilities. The FRAIL-HF study attempted to objectively evaluate patients’ ability to perform HF self-care tasks and correlate self-care ability with readmissions rates and one-year mortality.

Guest Authors: Holly Porras, PharmD and Emily Prohaska, PharmD, BCACP, BCGP

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Secondary Stroke Prevention in A-Fib: Do DOACs PROSPER in High-Risk Patients?

Secondary Stroke Prevention in A-Fib: Do DOACs PROSPER in High-Risk Patients?

November 22, 2019

Several guidelines now recommend direct oral anticoagulants (DOACs) as the preferred anticoagulants for patients with non-valvular atrial fibrillation (a-fib). However, the landmark clinical trials focused largely on the primary prevention of stroke.  Moreover, real-world data using DOACs for secondary prevention is lacking. Many have argued that warfarin might be a better choice in these high-risk patients because it requires routine monitoring and increases the patient’s contact with the healthcare system. Does the choice of anticoagulant make a difference in preventing recurrent stroke?

Guest Authors: Blaire White, PharmD; Amber Cizmic, PharmD, BCACP; and Tish Smith, PharmD, BCACP

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Under Pressure: Does Directly Observing Medication Administration Lower Blood Pressure?

Under Pressure: Does Directly Observing Medication Administration Lower Blood Pressure?

November 8, 2019

Treatment-resistant hypertension, the need for 4 or more medications to achieve goal blood pressure (BP), occurs in nearly 1 in 5 patients.1 But is it truly treatment-resistant? Nonadherence is often regarded as the primary cause in many patients.  But how can we distinguish between other causes of hypertension that should prompt additional diagnostic testing or treatment intensification? A recent study suggests there is a simple solution: watch them take their pills.

Guest Authors: Meagan Brown, PharmD, BCACP and Raven Jackson, PharmD

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Will Oral Semaglutide PIONEER the Way to Lower Cardiovascular Risk?

Will Oral Semaglutide PIONEER the Way to Lower Cardiovascular Risk?

October 24, 2019

Until recently, glucagon-like-peptide-1 (GLP-1) receptor agonists were only available as injectable products. Some clinicians and patients are reluctant to use injectable agents because they require additional patient education and can be intimidating.  If a GLP-1 receptor agonist were available in an oral dose form, it would be welcomed treatment option. But would the cardiovascular safety and benefits of oral GLP-1 receptor agonists be better, similar, or worse than their injectable siblings?

Guest Authors:  Sally Earl, PharmD, BCPS and Megan Supple, PharmD, BCACP

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Using CRP in COPD to Guide Treatment Decisions During Exacerbations

Using CRP in COPD to Guide Treatment Decisions During Exacerbations

October 11, 2019

Patients frequently present to outpatient clinics and community pharmacies with acute exacerbations of chronic obstructive pulmonary disease and clinicians have an important decision to make. Should they prescribe antibiotics? Patients may seek antibiotics as a quick fix to their symptoms, but many AECOPD are not caused by bacterial infection. Prescribing unnecessary antibiotics exposes patients to adverse effects and can increase antimicrobial resistance.  But not prescribing antibiotics could delay recovery if the exacerbation is of bacterial origin … or worse, result in an avoidable hospitalization and death. Could a simple, bedside test empower patients and prescribers to use antimicrobials more selectively?

Guest Author:  Brittany Schmidt, PharmD, BCACP

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Addressing the Adherence Problem: Do Med Sync Programs Really Work?

Addressing the Adherence Problem: Do Med Sync Programs Really Work?

September 27, 2019

The “silent killer” that impacts every ambulatory care practice is medication non-adherence.  Today, medication non-adherence is estimated to cause 125,000 preventable deaths every year and costs all of us $300 billion. It is no surprise that pharmacists have an important roll to play tackling this critical issue. Many pharmacies have now implemented medication synchronization or med sync programs to proactively address medication adherence.  While some have called med sync a “golden ticket,” research is clearly needed.

Guest Authors: Michael Kachmarsky, PharmD, BCACP and Daniel Longyhore, PharmD, MS, BCACP

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