jueves, 17 de mayo de 2018

Hospital admissions for bleeding events associated with treatment with apixaban, dabigatran and rivaroxaban | European Journal of Hospital Pharmacy


Hospital admissions for bleeding events associated with treatment with apixaban, dabigatran and rivaroxaban

Abstract

Objectives To analyse the hospital admissions for bleeding events associated with treatment with direct oral anticoagulants (DOACs). To describe the characteristics and outcomes of those patients.

Methods A retrospective observational study was carried out in the framework of an integral risk management plan of drugs and proactive pharmacovigilance of hospital admissions for bleeding associated with apixaban, dabigatran and rivaroxaban from April 2015 through December 2016. Cases were identified using the information management tool of Orion Clinic (hospital electronic medical history) and by reviewing the hospital discharge reports. Various biometric, clinical and pharmacotherapeutic variables of each patient were registered.

Results 37 hospitalisation episodes for DOAC-induced bleeding in 32 patients (15 received rivaroxaban, 9 apixaban and 8 dabigatran) were detected, representing an incidence rate of 3.44 per 100 person-years (95% CI 2.35 to 4.86). The most common bleeding site was gastrointestinal (27 cases, 73.0%). Intracranial bleeding was rare (three cases, 8.1%). Four patients (12.5%) were receiving DOACs at full doses and had a 'dose reduction indication'. The mean (SD) length of stay was 8.4 (5.2) days. Three patients (8.1%) died during the hospitalisation. Among bleeding episodes without fatal outcome, DOACs were stopped in 14 cases, continued in 14 cases, switched for another DOAC in two cases and the dose was reduced in four cases.

Conclusions DOACs are associated with serious bleeding events that require hospitalisation. The risk/benefit ratio assessment considering patient preferences and an individualised follow-up, especially in patients who are elderly, polymedicated or have impaired renal function, can help to reinforce the safe use of DOACs.

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martes, 15 de mayo de 2018

COMO ELEGIR LA GUIA ADECUADA



Choosing guidelines to use in your practice

James A. DickinsonNeil R. BellRoland GradHarminder Singh
Stéphane Groulx and Olga Szafran

In family medicine, time is of the essence. Family physicians
must make decisions quickly, while still retaining a scientific
approach and communicating with our patients to reach mutually
 agreeable solutions. For much of our work, we use a standard
 set of approaches—a “mindline” that enables a routine.1,2
Each day, we also encounter situations for which we do not
have a mindline and then must check some advisory source.
It is not possible for front-line family physicians to appraise the
 primary research for every situation; we must use research
summarized by others into material we can look up quickly.3
Many clinical decisions can be informed by recommendations
from practice guidelines.
Canadian Family Physician: 64 (5)


http://www.cfp.ca/content/64/5/357?rss=1