Let’s talk about the new anticoagulants. Two recent studies involving dabigatran (Pradaxa) have shed new light on an important topic for patients with atrial fibrillation: the risk of bleeding versus the risk of stroke. Dabigatran and rivaroxaban (and soon, apixaban) have been approved for the prevention of stroke in patients with non-valvular atrial fibrillation (AF). […]
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There was big news this week on the much-anticipated, but yet-to-be-evaluated novel blood thinner, apixaban (Eliquis). The FDA wants more information from the ARISTOTLE trial. They have inquired about “data management and verification.” That sounds serious. I made some comments about apixaban over at Trials and Fibrillations on theHeart.org. Here’s the mystery: Apixaban boasts incredibly […]
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How much Medicine is enough?
I’m going to tell you a secret about my office practice. (Yes, procedural-based doctors spend long hard days toiling in the office.) On office days, I often play a little game with my imaginary friend. He challenges me to leave the prescription pad in the drawer for the entire day. The idea being that patients […]
The safety of AF ablation depends greatly on the adequacy of blood thinning. AF ablation is no cardioversion. The choices of blood thinning regimens include either warfarin or dabigatran (Pradaxa)–and soon perhaps rivaroxaban or apixaban. The advantages of warfarin include the ability to confirm the level of thinness and its long-acting properties lessen after-procedure gaps […]
It’s crazy out there in blood thinner land. The novel blood thinning drug for patients with atrial fibrillation, Dabigatran (Pradaxa) cannot get a break. It’s all over the TV: Pradaxa = Bad Drug. Look at this image: Today, on the prestigious heart news site, theHeart.org, an insignificant 113-patient study presented as a poster at a […]
You may have heard that the new blood thinner, rivaroxaban (Xarelto) made news at the recent ACC meeting in Chicago. The Einstein PE trial showed rivaroxaban equivalent to standard therapy (enoxaparin followed by warfarin) in the treatment of pulmonary embolism (blood-clot in lungs). When the researchers looked at net clinical benefit, a measure that gives […]
My friend Bill is an ER doctor and a bike racer. He’s like me in that he has rediscovered the beauty of being a learner. His most recent area of inquiry is the blood clotting cascade and the use of reversal agents for the novel new blood thinners, (dabigatran, rivaroxaban and the soon to be […]
Let’s get off cell biology and back to something I really know. Atrial fibrillation, AF ablation and blood thinners. There was an important study published today in the Journal of the American College of Cardiology concerning the use of the new blood thinner, dabigatran (Pradaxa), around the time of AF ablation. A very concise overview, […]
The late-morning sessions addressed the possible mechanism(s) of AF. Many ask what causes AF. The assumption holds that if we can ablate AF, we must know what causes it. This would not be true. One line of thinking holds that disorganized electrical conduction throughout the atria plays an important role–not just focal drivers and initiators […]
The second half of the day was fast paced and full of information. Folks, these are rough notes. Hope they help…Again my random thoughts are in italics. Dr Eric Prystowsky led off the with the best clinical papers of 2011: He is a great speaker and hit upon a bunch of important topics. The good […]
You may have heard that AF is a tough disease to understand. Questions far outnumber answers. What causes AF? Why do some not feel it at all, while others are incapacitated? What’s the best treatment? Drugs? Ablation? Surgery? No treatment? Should I take a blood thinner…and which one? Where should one go for the best […]