My iPhone vibrated with an urgent message that read: Please call…The INR on your atrial fibrillation patient scheduled for cardioversion is too low. He is on that new blood thinner, Pradaxa. What do you want to do?” I responded, sounding like an expert: “It’s Ok. Pradaxa thins the blood adequately, it just doesn’t change the […]
Tag: Stroke
I loved my old status. Perhaps, reveled in it would be a better description. I was a crotchety generic-medicine only doctor.** Sadly, my status changed today. Dabigatran (Pradaxa) was the culprit. It was a little nerve-racking. I wrote the order, looked at it, thought it out again, talking to myself, “John, are you sure you […]
The dabigatran party isn’t even cleaned-up yet, when another warfarin competitor has hit the press wires. As reported on Cardiobrief from a Bayer press release, Rivaroxaban (Xarelto) was as effective as warfarin in stroke prevention in patients’ with AF. A composite of major and minor bleeding events were also similar to warfarin. Rivaroxaban is a […]
This morning I am told, “Dr Mandrola, there are two ladies from this company, Boehinger Ingelheim, who need to to give you a secret, sealed envelope.” I wonder whether the department of Health and Human Services knows about this exciting new potential warfarin substitute. Surely they do, as replacing the ubiquitous blood thinner warfarin with […]
The medical assistant who checked the patient in tells me, “Dr Mandrola, this guy had coronary artery disease since the 1980’s. He is 90 years-old now, and his only medicines are that statin and aspirin.” One of the more common questions that arises in cardiology is whether a person should take a statin drug. Despite […]
Is there a flawless medical therapy: a “wonder-drug” devoid of adverse effects, or a procedure without complications? Of course not. It’s why we have clinical trials. An intervention for a disease is determined beneficial or not by a clinical trial–the new treatment versus no treatment, or the current treatment. It really is that simple. […]
In cancer treatment, detection of a tumor in an early stage markedly increases the chance of favorable outcomes. Can the much-maligned blood thinner, warfarin, occasionally help in early detection of cancer? Few pharmacologic agents receive more bad press than warfarin. Stories, which are too numerous to count, like “Did warfarin kill my father,” can […]
He is 93 and has numerous medical problems, most of which involved aging blood vessels, as well as multiple orthopedic issues, including compression fractures and diffuse arthritis. The bony issues have resulted in a severely compromised mobility of late. Despite ongoing treatment with both aspirin and clopidogrel, he presents after numerous hours of focal neurologic […]