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JAMA Oct 2017Non-vitamin K oral anticoagulants (NOACs) are commonly prescribed with other medications that share metabolic pathways that may increase major bleeding risk.
IMPORTANCE
Non-vitamin K oral anticoagulants (NOACs) are commonly prescribed with other medications that share metabolic pathways that may increase major bleeding risk.
OBJECTIVE
To assess the association between use of NOACs with and without concurrent medications and risk of major bleeding in patients with nonvalvular atrial fibrillation.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective cohort study using data from the Taiwan National Health Insurance database and including 91 330 patients with nonvalvular atrial fibrillation who received at least 1 NOAC prescription of dabigatran, rivaroxaban, or apixaban from January 1, 2012, through December 31, 2016, with final follow-up on December 31, 2016.
EXPOSURES
NOAC with or without concurrent use of atorvastatin; digoxin; verapamil; diltiazem; amiodarone; fluconazole; ketoconazole, itraconazole, voriconazole, or posaconazole; cyclosporine; erythromycin or clarithromycin; dronedarone; rifampin; or phenytoin.
MAIN OUTCOMES AND MEASURES
Major bleeding, defined as hospitalization or emergency department visit with a primary diagnosis of intracranial hemorrhage or gastrointestinal, urogenital, or other bleeding. Adjusted incidence rate differences between person-quarters (exposure time for each person during each quarter of the calendar year) of NOAC with or without concurrent medications were estimated using Poisson regression and inverse probability of treatment weighting using the propensity score.
RESULTS
Among 91 330 patients with nonvalvular atrial fibrillation (mean age, 74.7 years [SD, 10.8]; men, 55.8%; NOAC exposure: dabigatran, 45 347 patients; rivaroxaban, 54 006 patients; and apixaban, 12 886 patients), 4770 major bleeding events occurred during 447 037 person-quarters with NOAC prescriptions. The most common medications co-prescribed with NOACs over all person-quarters were atorvastatin (27.6%), diltiazem (22.7%), digoxin (22.5%), and amiodarone (21.1%). Concurrent use of amiodarone, fluconazole, rifampin, and phenytoin with NOACs had a significant increase in adjusted incidence rates per 1000 person-years of major bleeding than NOACs alone: 38.09 for NOAC use alone vs 52.04 for amiodarone (difference, 13.94 [99% CI, 9.76-18.13]); 102.77 for NOAC use alone vs 241.92 for fluconazole (difference, 138.46 [99% CI, 80.96-195.97]); 65.66 for NOAC use alone vs 103.14 for rifampin (difference, 36.90 [99% CI, 1.59-72.22); and 56.07 for NOAC use alone vs 108.52 for phenytoin (difference, 52.31 [99% CI, 32.18-72.44]; P < .01 for all comparisons). Compared with NOAC use alone, the adjusted incidence rate for major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin and was not significantly different for concurrent use of verapamil; diltiazem; cyclosporine; ketoconazole, itraconazole, voriconazole, or posaconazole; and dronedarone.
CONCLUSIONS AND RELEVANCE
Among patients taking NOACs for nonvalvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin compared with the use of NOACs alone, was associated with increased risk of major bleeding. Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs.
Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Confounding Factors, Epidemiologic; Drug Interactions; Female; Hemorrhage; Humans; Logistic Models; Male; Middle Aged; Polypharmacy; Propensity Score; Retrospective Studies; Taiwan
PubMed: 28973247
DOI: 10.1001/jama.2017.13883 -
Cureus Jun 2023Facioscapulohumeral muscular dystrophy (FSHD) is the third most common type of muscular dystrophy. This disease presents as a slowly progressive asymmetric muscle... (Review)
Review
Facioscapulohumeral muscular dystrophy (FSHD) is the third most common type of muscular dystrophy. This disease presents as a slowly progressive asymmetric muscle weakness that involves the facial, scapular, and upper arm muscles mainly. Currently, there is no established consensus on this disease treatment in terms of medications. We assessed the response to the treatment of the drugs utilized in clinical trials by performing a systematic literature review in English using the preferred reporting items for systematic reviews (PRISMA) and meta-analyses. We only used human clinical trials in patients diagnosed with FSHD that received consistent pharmacological treatment. We included 11 clinical trials that fulfilled our criteria. We concluded that albuterol had statistically significant results in three out of four clinical trials, with improved elbow flexors muscle strength. Vitamin C, vitamin E, zinc gluconate, and selenomethionine showed significant improvement in the maximal voluntary contraction and endurance limit time of quadriceps muscle. At the same time, diltiazem and MYO-029 demonstrate no improvement in function, strength, or muscle mass. Losmapimod, currently in phase I of the ReDUX4 trial, showed promising results. Peradventure, more clinical trials are still needed to address this subject. Nevertheless, this review provides a clear and concise update on the treatment for this disease.
PubMed: 37404420
DOI: 10.7759/cureus.39903 -
Radiology Case Reports Jun 2022Myocarditis is the inflammation of the heart muscle with various clinical presentations and etiology. In this case, we demonstrate the utility of Fluorodeoxyglucose PET...
Myocarditis is the inflammation of the heart muscle with various clinical presentations and etiology. In this case, we demonstrate the utility of Fluorodeoxyglucose PET scan in identifying its etiology. A 28-year-old female with a history of undifferentiated connective tissue disease and sacroiliitis referred to the cardiology clinic for palpitations. Her symptoms started 3 years ago, were episodic, associated with fatigue, and impaired quality of her life. A resting electrocardiogram revealed sinus tachycardia. Medical workup for sinus tachycardia was unremarkable. Given suspicion for idiopathic myocarditis, a FDG PET using F18 was ordered and revealed diffuse myocardial uptake suggestive of myocarditis. Normal LV systolic function was noted on the echocardiogram. Her tachycardia was successfully treated with ivabradine and diltiazem. She was started on mycophenolate mofetil for myocarditis with improvement in symptoms of tachycardia and fatigue. A repeat FDG PET in follow-up revealed less diffuse uptake with the initiation of therapy. FDG-PET may add value in patients with inappropriate sinus tachycardia found especially if suspicion of underlying connective tissue disease exists. As illustrated in this case, a timely diagnosis could change management decisions as well as significantly impact the quality of life.
PubMed: 35464795
DOI: 10.1016/j.radcr.2022.03.074 -
The Yale Journal of Biology and Medicine Mar 2020Diltiazem is a calcium-channel blocker commonly used for the treatment of hypertension. Common adverse effects include dizziness, headache, and edema. Fewer than 20...
Diltiazem is a calcium-channel blocker commonly used for the treatment of hypertension. Common adverse effects include dizziness, headache, and edema. Fewer than 20 cases of diltiazem-associated photodistributed hyperpigmentation have been reported in the literature. Here, we present the case of a 71-year-old woman with new-onset facial hyperpigmentation 6 months after initiating treatment with diltiazem.
Topics: Aged; Biopsy; Calcium Channel Blockers; Dermatologic Agents; Diltiazem; Female; Humans; Hyperpigmentation; Hypertension; Ointments; Photosensitivity Disorders; Skin; Tacrolimus; Treatment Outcome; Withholding Treatment
PubMed: 32226335
DOI: No ID Found -
Actas Dermo-sifiliograficas Dec 2015Calcinosis cutis (CC) is defined as the deposition of calcium salts in the skin. The condition is divided into 5 types: calciphylaxis and dystrophic, metastatic,... (Review)
Review
Calcinosis cutis (CC) is defined as the deposition of calcium salts in the skin. The condition is divided into 5 types: calciphylaxis and dystrophic, metastatic, idiopathic, and iatrogenic CC. Dystrophic CC is the most common form and usually occurs in association with autoimmune diseases. CC can be treated surgically or with the use of drugs such as diltiazem, bisphosphonates, warfarin, ceftriaxone, probenecid, minocycline, or aluminum hydroxide. Calciphylaxis is defined as calcification of the media of small- and medium-sized blood vessels in the dermis and subcutaneous tissue. Clinically, calciphylaxis causes livedo racemosa, which progresses to retiform purpura and skin necrosis. First-line treatment is with sodium thiosulfate. We present a review of the calcifying disorders of the skin, focusing on their diagnosis and treatment.
Topics: Autoimmune Diseases; Calcinosis; Calciphylaxis; Calcium; Collagen Diseases; Diagnostic Imaging; Humans; Iatrogenic Disease; Phosphorus; Skin Diseases; Skin Diseases, Parasitic; Thiosulfates
PubMed: 26394755
DOI: 10.1016/j.ad.2015.09.001 -
Journal of Veterinary Cardiology : the... Jun 2023Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and...
OBJECTIVES
Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and tachycardias.
ANIMALS
Seventeen cats with VPE and 15 healthy matched-control cats.
MATERIAL AND METHODS
Multicenter case-control retrospective study. Clinical records were searched for cats with VPE, defined as preserved atrioventricular synchrony, reduced PQ interval, and increased QRS complex duration with a delta wave. Clinical, electrocardiography, echocardiographic, and outcome data were collated.
RESULTS
Most cats with VPE were male (16/17 cats), non-pedigree cats (11/17 cats). Median age and mean body weight were 5.4 years (0.3-11.9 years) and 4.6 ± 0.8 kg, respectively. Clinical signs at presentation included lethargy (10/17 cats), tachypnea (6/17 cats), and/or syncope (3/17 cats). In two cats, VPE was an incidental finding. Congestive heart failure was uncommon (3/17 cats). Nine (9/17) cats had tachyarrhythmias: 7/9 cats had narrow QRS complex tachycardia and 2/9 cats had wide QRS complex tachycardia. Four cats had ventricular arrhythmias. Cats with VPE had larger left (P < 0.001) and right (P < 0.001) atria and thicker interventricular septum (P = 0.019) and left ventricular free wall (P = 0.028) than controls. Three cats had hypertrophic cardiomyopathy. Treatment included different combinations of sotalol (5/17 cats), diltiazem (5/17 cats), atenolol (4/17 cats), furosemide (4/17 cats), and platelet inhibitors (4/17 cats). Five cats died, all from cardiac death (median survival time 1882 days [2-1882 days]).
CONCLUSIONS
Cats with VPE had a relatively long survival, albeit showing larger atria and thicker left ventricular walls than healthy cats.
Topics: Male; Cats; Animals; Female; Wolff-Parkinson-White Syndrome; Retrospective Studies; Pre-Excitation Syndromes; Tachycardia; Electrocardiography; Cat Diseases
PubMed: 37267820
DOI: 10.1016/j.jvc.2023.04.005