Say It Ain’t (Mostly) So? DOAC therapy for Stroke Prevention in Patients with Liver Disease and Atrial Fibrillation

Use of oral anticoagulation therapy in patients with liver disease is complex. The risks and benefits of therapy need to be considered as those with liver disease can be at heightended risk of bleeding. This blog post will review the literature surrounding the use of oral anticoagulation in patients with atrial fibrillation and liver disease and recommendations on selecting therapy, if any, will be discussed.

Antibiotics and Cardiovascular Adverse Effects: A Focus on Fluoroquinolones and Macrolides

Macrolides and fluoroquinolones (FQs) are two of the most commonly prescribed antibiotics; however, recent studies have revealed that these medications are associated with a higher risk of cardiovascular (CV) adverse events (AEs) including arrhythmias and valvular regurgitation. This blog summarizes recent literature on CV AEs associated with FQs and macrolides and provides recommendations on their use within certain at-risk populations.

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

The optimal antithrombotic regimen in patients with AF and comorbid CAD remains unclear. Current American College of Cardiology/American Heart Association guidelines provide minimal guidance on whether to continue antiplatelet therapy in combination with anticoagulation in this population. Additionally, while the 2017 European Society of Cardiology guidelines recommend oral anticoagulation alone, there is little supporting evidence for this recommendation. This blog discusses the implications of the recently published AFIRE study, which attempts to answer the question: In patients with stable CAD and AF, is combination therapy necessary or is anticoagulation monotherapy sufficient?

2020 Glow-Up: Does colchicine have a role post-MI?

Despite the known role of inflammation in atherosclerosis, interventions beyond statins that address this mechanism have been either unsuccessful or plagued with extreme costs and/or intolerable side effects. As a relatively low-cost and acceptably-tolerated medication, colchicine would be a practical choice to target the inflammatory nature of atherosclerosis and has shown promise in previous studies. This blog discusses the recent publication of the Colchicine Cardiovascular Outcomes Trial (COLCOT) and the implications for colchicine to reduce ischemic events.

Should DOACs be Used for Treatment of Cancer-Related Thromboembolism?

Patients with active cancer are at an increased risk of arterial and venous thromboembolism (VTE) and bleeding events. Until recently, low molecular weight heparins (LMWH) were generally the preferred therapeutic class for treatment of VTE in patients with cancer. However, LMWH use is limited in the outpatient setting by parenteral administration. Recently, direct oral anticoagulants (DOACs) have demonstrated efficacy in large randomized clinical trials of patients with both VTE and atrial fibrillation and are recommended over warfarin in certain populations. Given the attractive oral dosing option and lack of laboratory montioring, DOAC use have been used for VTE treatment for patients with cancer. In this blog, we summarize the available trial data and provide clinical recommendations for VTE treatment in patients with cancer.

What’s in the Black Box? Examining the Evidence for Five Cardiac Medications? Part 2

Boxed warnings appear in the product labeling for several cardiac medications. The purpose of a boxed warning is to minimize the risk of harm. In this second part of a two-part series, we’ll review the literature that led to the boxed warnings for edoxaban (Savaysa), prasugrel (Effient) and ticagrelor (Brilinta), along with practical considerations for their use.