It seems the pendulum is always swinging back and forth with the management of COPD. Few years ago, we have pulled away from the use of high dose inhaled corticosteroids when we found its association with increased risk of pneumonia and related mortalities. Here’s my post on this topic. And thus, the treatment strategy has shifted to using more long acting bronchodilators. These bronchodilators include LABA (long acting beta agonist) and LAMA (long acting muscarinic antagonist).
For individuals with atrial fibrillation who also require percutaneous coronary intervention, triple antithrombotic therapy with warfarin and two antiplatelet agents (e.g. Aspirin and Clopidogrel) has been the standard of care for post PCI management. However, this combination therapy is also associated with higher risk of bleeding. Recently, many research scientists have started looking at the utility of dual therapy with DOAC and a P2Y12 inhibitor such as clopidogrel or ticagrelor in the same setting. These results have finally been released for rivaroxaban and dabigatran.
What medications may increase bleeding risk for individuals taking NOACs (non-Vitamin K oral anticoagulants)? A recent article published in JAMA aimed to address this question. Chang et al published their work on assessing the association between the use of NOACs with or without concurrent medications and risk of major bleeding.
As we continue our experience with deprescribing medications, particularly with proton pump inhibitors, benzodiazepines, or chronic opioids, another drug class that is worth reviewing is beta blocker in the context of Post MI management.
It always get on my nerves to hear about drug shortages of important medications. Last week, I have been told that spironolactone is on back order nationwide. It is difficult to know when supply will be available again. So many clinicians need to think about a “Plan B” for patients currently taking spironolactone.
Just hot off the press from the JAMA Internal Medicine ……. is the release of the results demonstrating all-cause mortality benefits by intensively lowering blood pressure in patients with chronic kidney disease (stage 3-5). In this study, patients in the more intensive lowering group had 14% lower risk of all-cause morality than the less intensive group (odds ratio 0.86; 95% CI 0.76-0.97, p=0.01)
As my husband stood on the stage to celebrate his completion of the Cardiology Echocardiography fellowship program, it would be hard to imagine where he was a decade ago. When I first met him, he was barely making ends meet, studying tirelessly at night for various exams and working 2-3 jobs simultaneously during the day at pizza places, local pubs and data entry jobs.