Warfarin dosing nomogram for initiating therapy

A 60 year old female patient presents to the emergency department with complaints of swelling and pain in her right leg.  She recently had her knee replaced and has healed well since the procedure.  She has a PMH of HTN and CKD (Stage IV).  She has no other complaints at this time.  She is diagnosed with a proximal DVT on lower extremity ultrasound and the decision is made to anticoagulate her with warfarin plus a parenteral anticoagulant.  Her baseline INR is 1.28.  What strategy can we use to initiate her on warfarin to reach a therapeutic INR in a reasonable amount of time without overanticoagulating her?

Dabigatran reversal with idarucizumab (Praxbind)

A 77 year old black patient is admitted to the hospital for a gastrointestinal bleed.  He has a past medical history of CAD (MI 15 years ago), CKD (stage 4), atrial fibrillation, PUD, and hyperlipidemia for which he is taking ASA 81 mg daily, metoprolol tartrate 50 mg twice a day, atorvastatin 20 mg daily, lisinopril 20 mg daily, omeprazole 20 mg daily, and dabigatran 75 mg orally twice a day.  Initial labs indicate an aPTT of 95 seconds, hemoglobin of 6.8 g/dL, and serum creatinine 2.3 mg/dL.

Direct oral anticoagulants to treat VTE in patients with cancer?

Four direct oral anticoagulants were approved by the FDA in the last few years and are all now indicated for the treatment of DVT and PE.  These include:

• Direct thrombin inhibitor:

     -Dabigatran (Pradaxa)

• Factor Xa inhibitors:

     -Rivaroxaban (Xarelto)
     -Apixaban (Eliquis)
     -Edoxaban (Savaysa)


These medications are given orally at fixed doses and do not require coagulation monitoring or titration.  Compared to warfarin (which needs close INR following and can vary drastically

New drugs for heart failure plus review chart

The pharmacotherapy management of patients with heart failure with reduced ejection fraction is a populated landscape with multiple drugs affecting morbidity and mortality.  Two new medications that are the first in two new classes were approved recently - a neprilysin inhibitor and a hyperpolarization-activated cyclic nucleotide-gated channel blocker.

But first here's a quick table and a few notes about the current use of medications for treating heart failure with reduced ejection fraction.

10 things you should know about target-specific oral anticoagulants

Here are some stand-out facts and tips about the target-specific oral anticoagulants.  These agents are becoming increasingly popular in the last few years and there are some nuances among them that you’ll find here. 

To review, target-specific oral anticoagulants (TSOACs) includes dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa).  They’re given orally with either once or twice daily dosing and you don’t need to (and in fact, can’t) monitor any coagulation labs in the typical clinical setting. 

Risk of hyperglycemia from glucocorticoids

A 65 year old patient with COPD sees his primary care provider for worsening shortness of breath over the past week.  His current medications include tiotropium and albuterol.  He has no other significant past medical history but has a family history of diabetes.  His current labs include a fasting plasma glucose of 96 mg/dL, HbA1c of 6.1%, Scr = 0.8 mg/dL.  His primary care provider determines that the patient is having a COPD exacerbation and is opting to initiate a 5 day course of prednisone 40 mg orally daily (click here for more on a 5 days course versus longer steroid courses for COPD exacerbations).  What are some of the risk factors, the time-course, and the mechanism for developing hyperglycemia in a situation like this?