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?
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.
The TRED-HF trial considerably narrowed the population deemed as being low risk for heart failure relapse following the withdrawal of guideline-directed medical therapy (GDMT). However, several key subgroups were underrepresented and some patients may still wish to attempt GDMT withdrawal, especially in the setting of adverse effects or excess costs. In this post, we explore three questions that can be used to guide a shared decision-making process regarding GDMT withdrawal.
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.
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.
Boxed warnings appear in the product labeling for several cardiac medications. The purpose of a BW is to minimize the risk of harm. In this two-part blog series, we’ll review the literature that led to the BWs for cilostazol (Pletal), dofetilide (Tikosyn), edoxaban (Savaysa), prasugrel (Effient) and ticagrelor (Brilinta), along with practical considerations for each. Cilostazol and dofetilide will be discussed in this first post of the series.
The recent results of The Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial have, to say the least, brought into question the notion that ticagrelor is a superior P2Y12 inhibitor in patients with ACS. This blog will briefly review the results of ISAR-REACT 5, but more importantly outline key considerations for the use of prasugrel in clinical practice.
Questions regarding the role of sodium-glucose co-transporter-2 inhibitors (SGLT2i) in heart failure have been raised since the publications of EMPA-REG OUTCOME in 2015. The recent results of the Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure (DAPA-HF) shed some light on the potential for these medications in HFrEF. In this blog, we discuss the implications of DAPA-HF and the role of SGLT2i for heart failure, including perspectives from a cardiologist.
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end stage renal disease (ESRD). A significant number of patients with ESRD undergoing dialysis have reduced left ventricular ejection fraction. Contemporary treatment of heart failure with reduced ejection fraction (HFrEF) includes multiple pharmacotherapeutic strategies such as renin-angiotensin-aldosterone system inhibitors to reduce mortality and slow disease progression. However, because of concerns about hyperkalemia, aldosterone receptor antagonists are not commonly used in patients with HFrEF and ESRD undergoing dialysis. This blog summarizes the current evidence for efficacy and safety of aldosterone receptor antagonists in patients with concomitant HFrEF and ESRD requiring dialysis.
Residency preceptors must be able to demonstrate the ability to use the four preceptor roles. Applying these roles allows for due diligence when training pharmacy students and residents. In this two part blog post, we will review these roles (instruct, model, coach and facilitate) and discuss reasons for and examples of how to apply these.