Clinical medicine insights. Therapeutics最新文献

Identifying Clinical Predictors of Switching From Direct Oral Anticoagulants to Warfarin 确定从直接口服抗凝药物转向华法林的临床预测因素

Clinical medicine insights. Therapeutics Pub Date : 2019-01-01 DOI: 10.1177/1179559X19831287

Amber R Rollins, S. Hanigan, Kristen Pogue, E. Renner, G. Barnes, M. Dorsch

{"title":"Identifying Clinical Predictors of Switching From Direct Oral Anticoagulants to Warfarin","authors":"Amber R Rollins, S. Hanigan, Kristen Pogue, E. Renner, G. Barnes, M. Dorsch","doi":"10.1177/1179559X19831287","DOIUrl":"https://doi.org/10.1177/1179559X19831287","url":null,"abstract":"Direct oral anticoagulants (DOACs) have been shown to be as effective or superior to warfarin, but warfarin use remains constant. Knowledge regarding the patient population who have switched from a DOAC to warfarin is limited. The objective of this study was to identify clinical predictors which may influence a patient’s likelihood of switching from a DOAC to warfarin for atrial fibrillation (AF) or venous thromboembolism (VTE). In this single-center, case-control study, patients who switched from a DOAC to warfarin were compared with patients who remained on a DOAC. Baseline demographics were compared between the switch and control groups. Independent factors that increased the likelihood of switching from a DOAC to warfarin were analyzed using logistic regression. A total of 150 patients were included in the control (n = 100) and switch (n = 50) groups. Patients switched from a DOAC to warfarin had more medications at baseline (9 [7, 13] vs 11 [8, 18], P = 0.009). The presence of heart failure (HF) increased the likelihood of switching (odds ratio [OR] = 3.95, confidence interval [CI] = 1.70-9.21, P = 0.002), and for every 10 mL/min increase in creatinine clearance (CrCl), the likelihood of switching decreased ( R = 0.89 [0.80-0.99], P = 0.026). Patients with pulmonary embolism (PE) were less likely to switch from a DOAC to warfarin (OR = 0.20, CI = 0.05-0.86, P = 0.031). Explicitly listed reasons for switching included left ventricular assist device (LVAD) implantation (20%) and valve replacement procedures (20%). Congestive HF was a clinical predictor associated with an increased likelihood of switching from a DOAC to warfarin. Anticoagulation therapy for PE and higher CrCl was associated with a decreased likelihood in switching from DOAC to warfarin.","PeriodicalId":89907,"journal":{"name":"Clinical medicine insights. Therapeutics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179559X19831287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47771237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nonalcoholic Fatty Liver Disease: Epidemiology, Pathogenesis, Natural History, Diagnosis, and Current Treatment Options. 非酒精性脂肪肝:流行病学、发病机制、自然史、诊断和当前治疗方案。

Clinical medicine insights. Therapeutics Pub Date : 2016-01-01 Epub Date: 2016-12-18 DOI: 10.4137/cmt.s18885

Bubu A Banini, Arun J Sanyal

引用次数: 40

Safety and Efficacy of Ranolazine for the Treatment of Chronic Angina Pectoris. 雷诺拉嗪治疗慢性心绞痛的安全性和有效性

Clinical medicine insights. Therapeutics Pub Date : 2013-01-15 DOI: 10.4137/CMT.S7824

Mohammed Aldakkak, David F Stowe, Amadou K S Camara

{"title":"Safety and Efficacy of Ranolazine for the Treatment of Chronic Angina Pectoris.","authors":"Mohammed Aldakkak, David F Stowe, Amadou K S Camara","doi":"10.4137/CMT.S7824","DOIUrl":"10.4137/CMT.S7824","url":null,"abstract":"Coronary heart disease is a global malady and it is the leading cause of death in the United States. Chronic stable angina is the most common manifestation of coronary heart disease and it results from the imbalance between myocardial oxygen supply and demand due to reduction in coronary blood flow. Therefore, in addition to lifestyle changes, commonly used pharmaceutical treatments for angina (nitrates, β-blockers, Ca2+ channel blockers) are aimed at increasing blood flow or decreasing O2 demand. However, patients may continue to experience symptoms of angina. Ranolazine is a relatively new drug with anti-anginal and anti-arrhythmic effects. Its anti-anginal mechanism is not clearly understood but the general consensus is that ranolazine brings about its anti-anginal effects by inhibiting the late Na+ current and the subsequent intracellular Ca2+ accumulation. Recent studies suggest other effects of ranolazine that may explain its anti-anginal and anti-arrhythmic effects. Nonetheless, clinical trials have proven the efficacy of ranolazine in treating chronic angina. It has been shown to be ineffective, however, in treating acute coronary syndrome patients. Ranolazine is a safe drug with minimal side effects. It is metabolized mainly in the liver and cleared by the kidney. Therefore, caution must be taken in patients with impaired hepatic or renal function. Due to its efficacy and safety, ranolazine was approved for the treatment of chronic angina by the Food and Drug Administration (FDA) in 2006.","PeriodicalId":89907,"journal":{"name":"Clinical medicine insights. Therapeutics","volume":"2013 5","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2013-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32157565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cisplatin-Based Chemotherapy Options for Recurrent and/or Metastatic Squamous Cell Cancer of the Head and Neck. 头颈部复发和/或转移性鳞状细胞癌的顺铂化疗选择

Clinical medicine insights. Therapeutics Pub Date : 2013-01-01 DOI: 10.4137/CMT.S10409

Kelsey P Pendleton, Jennifer R Grandis

{"title":"Cisplatin-Based Chemotherapy Options for Recurrent and/or Metastatic Squamous Cell Cancer of the Head and Neck.","authors":"Kelsey P Pendleton, Jennifer R Grandis","doi":"10.4137/CMT.S10409","DOIUrl":"https://doi.org/10.4137/CMT.S10409","url":null,"abstract":"Recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is a devastating malignancy with a poor prognosis. Treatment is limited to chemotherapeutic approaches. Cisplatin is an established and effective treatment for R/M HNSCC, and many studies have investigated cisplatin treatment in combination with other agents. Even when being treated with first line therapy (cisplatin + 5-fluorouracil + cetuximab), overall survival is only 10 months, indicating the need for novel chemotherapeutics and treatment regimens. Current research is focused on molecular targeting therapies inhibiting epidermal growth factor receptor, phosphoinositide-3-kinase/Akt/mammalian target of rapamycin, and vascular endothelial growth factor pathways. A variety of clinical trials have been completed and are currently underway with encouraging results. Finally, future directions of cisplatin-based R/M HNSCC treatment may include targeting specific pathways known to induce cisplatin resistance, such as nucleotide excision repair and inhibition of apoptosis, in hopes to enhance response to cisplatin therapy.","PeriodicalId":89907,"journal":{"name":"Clinical medicine insights. Therapeutics","volume":"2013 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/CMT.S10409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31899394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 57