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Posts Tagged ‘noac’

Essential hematology for cardiologist

Posted in Uncategorized, tagged , , , , , , , , , , , , , , , , , , on November 15, 2023| 1 Comment »

Forget NEJM, Circulation, JACC, for some time. Hope & wish every one of us is aware of a journal called Blood, bringing stunning and dramatic discoveries week after week ,about the most crucial fluid that sustains our life. The journal Blood is published by the American Society of Hematology since 1949. Its impact factor is currently 20.8, celebrating its 75th year of existence .

We know, heart disease consistently tops the global mortality and morbidity charts . Without blood, heart is just a purposeless organ with four empty chambers. More than ninety percent of the cardiac mortality happens due to freezing and interruption of blood flow to the vital organs. Can any one dispute, heart is an Innocent bystander, when ACS happens due to an unscheduled pitched battle between blood and the coronary arterial wall ?

It is no surprise ,cardiologists spend most of their practicing time, fighting blood from freezing and trying to restore the flow. It is hard to believe there is absolutely little interaction between Hematologists and cardiologists dealing with the same organ.

Meanwhile, the drugs we use , pose a constant threat of bleeding elsewhere.As a clinician and cardiologist, anxious queries from our fellows such as this one are not infrequent. Sir, that lady with a prosthetic valve in room 306, is bleeding in gums . Should I stop the OAC ? She is also getting clopidogrel for the recent PCI. What shall we do?

Want answers to such questions ? Need to spend time guys. In an excellent review article, the prestigious journal talks about tackling bleeding patients and how to counter various drugs that can cause bleeding.

Reversal strategies in a bleeding patient

This table is just a sample from the paper. Thankfully full text is free in its site.

BLood820746Download

Final message

It seems , there are about 30,000 medical journals listed in Pubmed . Cross-specialty reading for relevant, up-to-date knowledge is always welcome. This will help us come out of the undesirable tag of super specialist or individual organ specialist.

Looking forward to the days when hematologists and cardiologists sit together frequently to discuss the strategies in unexplained ACSs, DVTs, other procoagulant (as well as pro-bleeding conditions)

With more and more metallic foreign bodies ,making heart as their residence, this type of Interactions will become all the more important.

Reference

Piran S, Schulman S. Treatment of bleeding complications in patients on anticoagulant therapy. Blood. 2019 Jan 31;133(5):425-435. doi: 10.1182/blood-2018-06-820746.

Next thought

Trying to go deep into this journal, and find the truth behind Red and white clot , which I never understood right from the medical school days.

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Chronic stable AF on warfarin: Don’t DOAC them just like that!

Posted in Uncategorized, tagged , , , , , , , on October 12, 2023|

Are you still on warfarin? Come on, switch to DOAC./NOAC This seems to be a fashion statement among cardiologists and their patients with chronic AF. (By the way, NOAC has a new name, i.e., DOAC. NOAC stands for non-vitamin K anticoagulants. Now, N is replaced with D, direct-acting oral anticoagulants.)

NOAC does have some advantages. the major one is better patient compliance, and ease of administration as it doesn’t need routine monitoring. (One may wonder how this transforms into a real advantage? ) The drug acts in a dark invisible mode. Bleeding risks are either less, equivocal, or high. So we can’t conclude conclusively on true bleeding risk.

(We do have some cumbersome monitoring methods for NOACS)

(Rahmat NA Monitoring the Effects and Antidotes of the Non-vitamin K Oral Anticoagulants. Arrhythm Electrophysiol Rev. 2015 Aug;4(2):90-5. )

Switching games with DOAC

A detailed review of how and when to switch is in this article Adelakun BMJ open 2023

Switching to DOACs should be based on some solid scientific principles. (Of course, we have it !) But, getting rid of INR monitoring should not be the only reason. Still, the current thought process among us is to consider DOAC whenever possible or (if not make it possible somehow). In this context, this study from Circulation September 2023 (Ref 1)helps to choose which side of the OAC-DOAC debate one should fall, especially in the elderly.

Final message

Dad, are you still using that frail iPhone 11? I feel bad, will get you an iPhone 15 Pro. Its just out in Apple stores. You know, it has dynamic island technology. Wish to gift it to you this Diwali.

Oh, thanks, but I’m fine with the oldy. I can comfortably communicate with whoever I want to.Don’t enforce me, I will stick on with warfarin, my dear son.

Reference

1.Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. Circulation 2023;Aug 27:[Epub ahead of print].

2.Adelakun AR, Turgeon RD, De Vera MA, McGrail K, Loewen PS. Oral anticoagulant switching in patients with atrial fibrillation: a scoping review. BMJ Open. 2023 Apr 25;13(4):e071907. doi: 10.1136/bmjopen-2023-071907. PMID: 37185198; PMCID: PMC10151984.

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