Dr. Wheeler:
Per your request, I completed a literature search using UptoDate and GoogleScholar. I performed searches using the terms, drug eluding stents, antiplatelet therapy duration, pci and stents, and antithrombotic therapy. I found some information that may help in answering your question.
In patients with a drug eluding stent dual antiplatelet therapy of aspirin and a P2y12 inhibitor is recommended. The dual antiplatelet therapy will reduce the chances of stenosis, heart attacks and sequentially death. Aspirin and one of the P2y12 inhibitors of which include Clopidogrel, Prasugrel or Ticagrelor has been shown to be most effective. The American College of Chest Physicians Evidence Based Clinical Practice Guidelines recommends that patients who have received percutaneous coronary interventions with drug eluding stents should receive 3 to 6 months of dual antiplatelet therapy. The minimum of 3 months is recommended for limus stents and 6 months is recommended for taxel stents. This recommendation is made with Grade 1A evidence. The shorter duration of dual antiplatelet therapy will reduce the risk of bleeding, however chances of early discontinuation will increase chances of stent thrombosis.
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In a patient, for example, that may have renal failure, dyslipidemia or diabetes therapy may be warranted longer in order to prevent stent thrombosis. Cutlip recommends that if the patient does not have any major bleeding such as intracranial, retroperitoneal or intraocular that dual antiplatelet therapy can be extended up to 18 months. We must weigh the benefit vs. risks in all patients with drug eluding stents receiving dual antiplatelet
Coumadin, whose generic name is Warfarin, and is manufactured by Bristol-Myers Squibb Company, is an anticoagulant medication. It is more commonly known as a “blood thinner”; however it does not actually thin the blood. An anticoagulant helps your body control how fast your blood clots and it prevents clots from forming during certain medical conditions. Medications such as Coumadin may prevent an already present clot from getting any larger and may also prevent a piece of the clot from breaking off and traveling to your heart, brain or lungs. Anticoagulants do not dissolve blood clots but with time, clots may dissolve on their own. (Cleveland Clinic, 2014)
After review of the clinical information provided by North Central Bronx Hospital, the Medical Director has denied your admission to North Central Bronx Hospital. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. You are a 56 year old female with complaints of worsening pressure-like chest pain on the left sided that radiated to your left arm and neck. The symptoms began when you were at rest and woke you from your sleep. Based on the Interqual guideline (a decision based program to determine medical need) criteria to for acute coronary syndrome the clinical guidelines were not met because troponins were negative, there was no diagnostic testing such as a stress test, or documentation of ischemia in the clinical information that was submitted.
The senior counselor met with Yommala to address a concern about patient #3944 medical order dated 10/2/2017: “Patient having surgery today to place stents near the heart. HCRC was not aware and was not given any prior paperwork. Pt informed needs to return with discharge paperwork prior to dosing.”
27-Ussia GP, Scarabelli M, Mulè M, et al. Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation.Am J Cardiol 2011;108:1772–6.
Many factors can increase the risk of these clots, including prolonged bed rest (such as after surgery), sitting for long periods (such as on a plane), use of birth control pills or hormone replacement therapy, pregnancy, family history of DVT, inflammatory bowel disease, and certain genetic clotting disorders. Compression stockings are also sometimes used in people who have an acute DVT, to prevent a group of symptoms known as post-thrombotic syndrome that includes leg pain and
(14) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD.. (2009). Dabigatran versus warfarin in patients with atrial fibrillation.. New England Journal Of Medicine. 361 (12), 1139-51.
For people who suffer with hemorrhoids, the discomfort and pain is both real and embarrassing. Unfortunately, because it's such a sensitive topic, many people are reluctant to talk to family and friends to find out what works. In many ways, this doesn't make sense: as unpleasant a subject as it may be, it's important to realize that most people will someday have this problem. Why so many? It's because hemorrhoids are caused by so many ordinary activities. If you lift something that is heavy, are pregnant, have difficulty with constipation – all of these can cause hemorrhoids. Doctors say that anywhere between 50-75% of all Americans will someday experience this problem.
Ofri, D (2000). Diagnosis and Treatment of Deep-Vein Thrombosis. Western Journal of Medicine; 173: 194-197.
...lood Vessel Stents.” 1-3). Bypass surgery is another option; a blood vessel from somewhere in the body is used to go around the blocked artery. This completely bypasses the blocked artery, so it no longer becomes an issue. Thrombolytic therapy is a method that involves injecting a medication into the artery that will dissolve the clot and allow blood to pass freely through the artery (“Peripheral Artery Disease.” 3).
Varicose (VAR-i-kos) veins are enlarged veins that can be blue, red, or flesh-colored. They often look like cords and appear twisted and bulging. They can be swollen and raised above the surface of the skin. Varicose veins are often found on the thighs, backs of the calves, or the inside of the leg. During pregnancy, varicose veins can form around the vagina and buttocks.
Jack need to understand the importance of the drugs that he is taking and how they work in terms that are understandable to him. Cholesterol lowering can be beneficial after CABG because, it can halt the progression of atherosclerosis in both native and graft vessels. He should be informed while taking Crestor he may experience increased blood sugar levels and his last HgA1c, was nine. Therefore, he will be informed that his blood-sugar levels should be checked regularly while taking Crestor. He also needs to be aware of the consequences of not taking his medication and failing to return for follow-up visits.
Certificate in Minor Oral Surgery Cohort 3 2014-15 Formative Assignment 1 Anticoagulant therapy is a relatively common long term treatment in UK medicine. Outline what medical conditions might indicate its use.
Mrs. Green was admitted to hospital as she was experiencing chest pain that was continuous for around 10 minutes. During her admission in the emergency department she had a 12 lead Electro-cardiogram (ECG) which indicated that she was having a ST Elevation myocardial infarction (STEMI) (School of Nursing & Midwifery 2014). Mrs. Green was then taken to have a percutaneous transluminal angioplasty which stents were placed, that was completed using a femoral approach and then was transferred to the cardiac care ward and is planned to be discharged the next day (School of Nursing & Midwifery
... you should take baby aspirin (81 mg). The earlier a patient takes preventative measures the less a patient has to worry about taking other medication such Warfarin which have many adverse side effects such as excessive bleeding. Patients need to continuously check legs for any signs and symptoms of DVT.
Deep Vein Thrombosis Symptoms, Causes and Treatment Introduction Deep vein thrombosis or DVT, is an endovascular disorder which occurs when a blood clot (thrombus), forms in one or more of the deep veins in the body. DVT usually occurs in the legs. Certain medications which affect how the blood clots can cause DVT to develop. DVT can also develop if you don’t move for a long time, usually after a surgery or accident, or when an individual is confined to bed.