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.
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.
Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) often occur concomitantly. Despite this, optimal treatment strategies remain unclear. Current rate and rhythm control pharmacotherapy options present challenges when used in patients with HFrEF. In this blog, we cover 3 clinical pearls to consider for acute management of AF in patients with HFrEF.
When it comes to triple therapy, the totality of the evidence strongly suggests “less is more”. While many practitioners have been quick to adopt dual antithrombotic therapy, it is important to consider the external validity of these trials and how we apply them to our patients. In this blog, Dr. Noel offers 3 considerations that require careful reflection before throwing in the towel on triple therapy.
Part III of this three part series focuses on the role of warfarin in end stage renal disease (ESRD). Is it time to retire warfarin for anticoagulation in patients with ESRD and atrial fibrillation (AF)? Are there supporting data for warfarin in patients with ESRD? How does it compare to apixaban? Check out the blog for full details and answers to these questions.
Part II of this three part series focuses on apixaban in end stage renal disease. Is it safe? How does it compare to warfarin? What dose should you use? Check out the blog for full details and answers to these questions.
Unsure how to handle the angiotensin II receptor blocker recalls? Check out our table of comparable doses to select an appropriate alternative!
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.