AC in ESRD (Part 1): First, Do No Harm – No Anticoagulation in Patients with End Stage Renal Disease and Atrial Fibrillation

Selecting the best anticoagulation strategy for patients with end stage renal disease and atrial fibrillation remains controversial. In this three part series, we will explore potential strategies that seek to balance the risk of stroke with adverse effects in patients with end stage renal disease and atrial fibrillation. In Part 1 of this series, we will discuss the risks of anticoagulation and provide a compelling argument for avoiding anticoagulation. The role of direct oral anticoagulants and warfarin in this patient population will be reviewed in Parts 2 and 3, respectively.

Post-TAVR Antithrombotic Therapy: What To Do When No One Knows What To Do.

Transcatheter aortic valve replacement (TAVR) has proven to be an effective treatment option for patients with severe aortic stenosis at intermediate-high risk for complications with surgical aortic valve replacement. In spite of the growing popularity of TAVR, the optimal antithrombotic regimen remains unknown. This blog outlines current guideline recommendations for post-TAVR antithrombotic therapy and gives guidance on how to handle special populations and patient-specific factors.

Transitions Squared: Transitioning Sacubitril/Valsartan at Transitions of Care

One of the questions that remained unanswered after the PARADIGM-HF trial was whether the angiotensin receptor/neprilysin inhibitor sacubitril/valsartan could be safely initiated in patients with acute decompensated heart failure who had been previously stabilized on an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker. In this blog, Dr. Reed discusses the implications of the PIONEER-HF and TRANSITION studies, and provides a practical strategy for transitioning patients to sacubitril/valsartan.

Cutting through the Fat: Digesting the 2018 ACC/AHA Cholesterol Guidelines

The long-awaited American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines were recently released at AHA 2018 in Chicago. This update can be described as an amalgamation of various previous guidelines and highlights the growing complexity of lipid management. In this post, we highlight some of the most important changes in the latest update.

Propofol-Induced Myocardial Depression: Does This Really Exist?

In the intensive care setting, propofol is a commonly used medication for management of sedation in mechanically ventilated, critically ill patients. However, intensivists often select dexmedetomidine over propofol in patients with cardiovascular disease due to concern for cardiac adverse effects such as myocardial depression. In this blog, I’ll be discussing three important considerations before accepting propofol-induced myocardial depression as clinically significant.

The Short End of the Stick: Practical Management of Cardiovascular Drug Shortages

Since 2010, the revolving door of unavailable drugs has forced healthcare workers to do (and spend) more with less. As such, pharmacists are being called upon to come up with creative and savvy solutions to combat the drug shortage crisis, all while ensuring patient care is not compromised. Few areas of acute care practice remain unaffected, including the cardiac care unit. In this bog, Dr Noel highlights recent, current, or probable drug shortages that have direct impact on cardiovascular care, and provides alternative medication options and clinical caveats for consideration.

Aspirin for Primary Prevention: Have We ARRIVEd at an Answer?

Evidence from multiple recent trials has brought to question the role of aspirin for primary prevention of cardiovascular disease. This remains common practice in the United States, despite questionable data to identify a population for whom the benefits outweigh the risks. In this blog, I compare recent evidence to current guideline recommendations and speculate whether or not aspirin will have a role for this indication in the future.