1) A meta-analysis of 4 large randomized controlled trials compared novel oral anticoagulants to warfarin in patients with atrial fibrillation.
2) The analysis found that novel oral anticoagulants were associated with lower rates of stroke or systemic embolism and lower rates of major bleeding compared to warfarin.
3) Mortality was also lower in patients taking novel oral anticoagulants.
Newer Oral Anticoagulants In Atrial Fibrillation - Dr Vivek BaligaDr Vivek Baliga
In this presentation, Dr Vivek Baliga, Baliga Diagnostics Bangalore, discusses the role of new oral anticoagulants in the management of non-valvular atrial fibrillation.
there are several limitation in VKA,to over come these problem NOACs came in picture but still limited indication for NOACs currently,required further study inter and intra comparison between anticoagulants.
- Describe the basic characteristics of new oral anticoagulants (OACs)
- Recognize potential candidates for new anticoagulants for atrial fibrillation and treatment of venous thrombosis
Newer Oral Anticoagulants In Atrial Fibrillation - Dr Vivek BaligaDr Vivek Baliga
In this presentation, Dr Vivek Baliga, Baliga Diagnostics Bangalore, discusses the role of new oral anticoagulants in the management of non-valvular atrial fibrillation.
there are several limitation in VKA,to over come these problem NOACs came in picture but still limited indication for NOACs currently,required further study inter and intra comparison between anticoagulants.
- Describe the basic characteristics of new oral anticoagulants (OACs)
- Recognize potential candidates for new anticoagulants for atrial fibrillation and treatment of venous thrombosis
K. thanavaro the indications and uses of the novel anticoagulantsAlysia Smith
Dr. Kristin Thanavaro, MD presents on "The Indications and Uses of the Novel Anticoagulants" at the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.
K. thanavaro the indications and uses of the novel anticoagulantsAlysia Smith
Dr. Kristin Thanavaro, MD presents on "The Indications and Uses of the Novel Anticoagulants" at the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
Prevention of recurrent stroke in atrial fibrillation Jacek StaszewskiJacek Staszewski
Prevention of recurrent stroke in atrial fibrillation. Comaprison of NOAC vs VKA. Riks of hemorrhagic stroke. When anticoagulation should be initiated following acute stroke.
A review of the existing evidence that supports the current practice in perioperative medicine regarding Renin-angiotensin-aldosterone system antagonists, mainly ACE inhibitors and Angiotensin type 1 receptor blockers (ARB's).
Presented as the Cleveland Clinic Hospital Medicine Grand Rounds on April 1, 2009. CME AMA Category 1 - 1 hour.
Dabigatran for Atrial Fibrillation: Cardioversion and Ablationlarriva
The presentation covers background information regarding atrial fibrillation (A-fib) and the use of oral anticoagulant dabigatran surrounding cardioversion and ablation for A-fib. The information surrounds a patient case in which the patient prefers dabigatran over warfarin. Available literature on the topic is analyzed to make a patient specific recommendation.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
4.
Meta-analysis is a systematic review of a focused topic
in the literature that provides a quantitative estimate
for the effect of a treatment intervention or exposure
Meta-analysis
Mark W. Russo How to Review a Meta-analysis.Gastroenterology & Hepatology Volume
3, Issue 8 August 2007
5.
AF is defined as a cardiac arrhythmia with the following
characteristics:
The surface ECG shows ‘absolutely’ irregular RR intervals
There are no distinct P waves on the surface ECG
The atrial cycle length is usually variable and <200 ms (>300
bpm).
Atrial Fibrillation-definition
6. Previous stroke or TIA
Age > 75
Structural heart disease
Hypertension
Previous MI
Moderate to severe LV dysfunction in echo
Complex aortic plaque in TOE
Marked LA enlargement(>5.0 cm)
Risk factors for stroke in AF
Diabetes-Not a convincing
predictive factor
Michael Hughes et al. Stroke and thromboembolism in atrial fibrillation: A systematic
review. Thromb Haemost 2008; 99: 295–304
7.
CHADS2 score
C Congestive Heart Failure 1 point
H Hypertension 1 point
A Age75 y 1 point
D Diabetes 1 point
S2 Stroke 2 points
Score 0=aspirin
Score 1=aspirin or oral anticoagulation
Score 2=oral anticoagulation
8.
CHADS2 & Stroke rate
Validation of clinical classification schemes for predicting stroke: results from the
National Registry of Atrial Fibrillation. JAMA 2001;285:2864–2870
9.
CHA2DS2-VASc Score
C Congestive Heart Failure 1 point
H Hypertension 1 point
A2 Age_75 y 2 points
D Diabetes 1 point
S2 Stroke 2 points
V Vascular disease 1 point
A Age_65 y 1 point
Sc Sex category, female 1 point
Score 0= no therapy or aspirin (no therapy preferred)
Score 1= aspirin or oral anticoagulation (oral anticoagulation preferred)
Score 2= oral anticoagulation
10.
Mason et al CHA2DS2-VASc Score and Anticoagulation for Atrial Fibrillation. The
American Journal of Medicine, Vol 125, No 6, June 2012
11.
HAS-BLED
H Hypertension 1
A Abnormal renal and liver function(1
point each)
1 or 2
S Stroke 1
B Bleeding 1
L Labile INRs 1
E Elderly (>65 years) 1
D Drugs or alcohol (1 point each) 1 or 2
Score > 3 is high risk for bleeding
14.
For patients with AF, (including paroxysmal AF) who are at
low risk of stroke (eg, CHADS2 score=0), we suggest no
therapy rather than antithrombotic therapy (Grade 2B)
For patients who do choose antithrombotic therapy, we
suggest aspirin (75 mg to 325 mg once daily) rather than oral
anticoagulation (Grade 2B) or combination therapy with
aspirin and clopidogrel (Grade 2B)
Antithrombotic Therapy for Atrial Fibrillation
ACCP guidelines 9th ed.
CHEST 2012; 141(2)(Suppl):e531S–e575S
15.
Who are at intermediate risk of stroke (eg, CHADS2 score=1),
we recommend oral anticoagulation rather than no therapy
(Grade 1B) . We suggest oral anticoagulation rather than
aspirin or combination therapy(Grade 2B).
For patients who are unsuitable for or choose not to take an
oral anticoagulant, we suggest combination therapy with
aspirin and clopidogrel rather than aspirin(Grade 2B)
Antithrombotic Therapy for Atrial Fibrillation
ACCP guidelines 9th ed.
CHEST 2012; 141(2)(Suppl):e531S–e575S
16.
Who are at high risk of stroke (eg, CHADS2 score= 2), we
recommend oral anticoagulation rather than no therapy
(Grade 1A) , aspirin or combination therapy(Grade 1B).
For patients who are unsuitable for or choose not to take an
oral anticoagulant, we recommend combination therapy with
aspirin and clopidogrel rather than aspirin(Grade 1B)
Antithrombotic Therapy for Atrial Fibrillation
ACCP guidelines 9th ed.
CHEST 2012; 141(2)(Suppl):e531S–e575S
17.
For patients with AF, (including paroxysmal AF) for
recommendations in favor of oral anticoagulation we suggest
dabigatran 150 mg bd rather than adjusted-dose warfarin
(target INR range, 2.0-3.0) (Grade 2B)
Exception: AF with MS, AF with CAD
Antithrombotic Therapy for Atrial Fibrillation
ACCP guidelines 9th ed.
CHEST 2012; 141(2)(Suppl):e531S–e575S
18.
AF and Mitral Stenosis: warfarin (INR-2.0 to 3.0)
AF with stable CAD: warfarin (INR-2.0 to 3.0)
AF with high risk and 1st month of bare metal stent or 3 to 6 month
of drug eluting stent: triple therapy (warfarin, aspirin,
clopidogrel).
After this period till 12 motnhs: warfarin and aspirin/clopidogrel
After 12 months: same as AF with stable CAD
Antithrombotic Therapy for Atrial Fibrillation
ACCP guidelines 9th ed.
CHEST 2012; 141(2)(Suppl):e531S–e575S
19.
AF with low/intermediate risk till 12 months of stent: dual
antiplatelet therapy
After this period: same as AF with stable CAD
AF with acute CAD, no stent, till 12 months: warfarin plus
aspirin/clopidogrel
After this period: same as AF with stable CAD
Antithrombotic Therapy for Atrial Fibrillation
ACCP guidelines 9th ed.
CHEST 2012; 141(2)(Suppl):e531S–e575S
20.
In pts “unsuitable” for oral anticoagulation due to a
specific risk of bleeding, patient preference or physician
preference
Reduced the risk of major vascular events (6.8% vs 7.6%
per year), especially stroke(2.4% vs 3.3% per year)
Increased the risk of major hemorrhage (2.0% vs 1.3% per
year)
ACTIVE-A (Effect of Clopidogrel Added to Aspirin in
Patients with Atrial Fibrillation) trial
Class IIb in 2011 ACCF/AHA/HRS Focused Update on the Management of Patients
With AFib
22.
Warfarin
Vitamin K antagonist
Oral, i.v, rectal-bioavailability nearly complete
T1/2=25 to 60 hours (≈40 hours), duration of action= 2 to 5
days
Monitoring: PT(INR)
Antidote: Vitamin K1(phytonadione), FFP
Vitamin K antagonist
23.
Genotype testing for CYP2C9 and VKORC1 (FDA
suggested)
Slow onset and offset of action (TTI)
Narrow therapeutic range
Regular monitoring (TTR)
Drug interactions
Problems with warfarin
TTI- Time To INR
TTR- Time in Therapeutic Range
24.
Direct Thrombin inhibitors:
Ximelagatron
Dabigatran
Factor Xa inhibitors:
Rivaroxaban
Apixaban
Edoxaban
New OAC
25. Direct Thrombin inhibitor (both free and clot bound IIa)
T1/2=12 – 17 hours
GFR >30ml/min:150 mg bd, GFR 15 to 30 ml/min: 75 mg bd
90-95% unchanged in urine, rest in bile. Dialysable.
PT, aPTT, TT
No antidote. Prothrombin concentrate or rVIIa may be used.
RE-ALIGN trial: significantly more thromboembolic events and
excess of major bleeding in patients with prosthetic heart valves
Dabigatran
26.
Randomized Evaluation of Long Term Anticoagulation Therapy
N Engl J Med 2009; 361:1139-51(RE-LY; dabigatran)
Cumulative Hazard Rates for the Primary Outcome of Stroke or Systemic Embolism, According to Treatment
Group
27.
As compared to warfarin(1.69% per year of 1⁰ outcome):
Dabigatran 110 mg- similar rate(1.53% per year) of stroke
and systemic embolism, lower rates of major haemorrhage.
Dabigatran 150 mg-lower rates(1.11% per year) of stroke
and systemic embolism, similar rates of major
haemorrhage
Randomized Evaluation of Long Term Anticoagulation Therapy
N Engl J Med 2009; 361:1139-51(RE-LY; dabigatran)
28. Reversible Factor-Xa inhibitor, activity also on thrombin and
factor VII
T1/2=5-13 hours
20 mg od, if GFR 30 to 49 ml/min: 15 mg od
CYP3A4 metabolism, 70% renal and 30%fecal elimination
No antidote. Prothrombin concentrate or rVIIa may be used.
Monitoring: anti Factor Xa assay, PT, aPTT
It is not for patients with artificial heart valves
Rivaroxaban
29.
Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition
Compared with Vitamin K Antagonism for Prevention of Stroke
and Embolism Trial in Atrial Fibrillation
(ROCKET AF) N Engl J Med 2011;365:883-91
30.
1.7% per year vs 2.2% per year (P<0.001 for non-inferiority)
2.1% per year vs 2.4% per year (P = 0.12 for superiority)
There was no significant between-group difference in the risk
of major bleeding, although intracranial and fatal bleeding
occurred less frequently in the rivaroxaban group
Funded by Johnson & Johnson and Bayer
Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition
Compared with Vitamin K Antagonism for Prevention of Stroke
and Embolism Trial in Atrial Fibrillation
(ROCKET AF) N Engl J Med 2011;365:883-91
31.
Reversible Factor-Xa inhibitor
T1/2=8-15 hours
5 mg bd
CYP3A4 metabolism. 30% renal and 70% fecal elimination
Minimal p-gp interaction
Anti factor Xa assay, PT, aPTT
No antidote
Apixaban
32.
Apixaban for Reduction in Stroke and Other
Thromboembolic Events in Atrial Fibrillation
(ARISTOTLE) N Engl J Med 2011;365:981-92.
33.
Apixaban reduced the risk of (in comparison to warfarin)
stroke or systemic embolism by 21%
major bleeding by 31% and
death by 11%.
Apixaban (5mg bd/ 2.5 mg bd in subsets) was superior to
warfarin
Funded by Bristol-Myers Squibb and Pfizer
Apixaban for Reduction in Stroke and Other
Thromboembolic Events in Atrial Fibrillation
(ARISTOTLE) N Engl J Med 2011;365:981-92.
34.
Reversible Factor Xa inhibitor
T1/2=9-10 hours
50% renal clearance
60 mg od
Anti factor Xa assay, PT, aPTT
No antidote
Edoxaban
35.
Effective Anticoagulation with Factor Xa Next Generation in
Atrial Fibrillation–Thrombolysis in Myocardial Infarction 48
(ENGAGE AF–TIMI 48) N Engl J Med 2013;369:2093-104
36.
Effective Anticoagulation with Factor Xa Next Generation in
Atrial Fibrillation–Thrombolysis in Myocardial Infarction 48
(ENGAGE AF–TIMI 48) N Engl J Med 2013;369:2093-104
37.
Both (30mg & 60mg) once-daily regimens of edoxaban were
noninferior to warfarin with respect to the prevention of
stroke or systemic embolism and were associated with
significantly lower rates of bleeding and death from
cardiovascular causes
Funded by Daiichi Sankyo Pharma Development
Effective Anticoagulation with Factor Xa Next Generation in
Atrial Fibrillation–Thrombolysis in Myocardial Infarction 48
(ENGAGE AF–TIMI 48) N Engl J Med 2013;369:2093-104
38.
Novel Oral Anticoagulants in Atrial Fibrillation: A
Meta-analysis of Large, Randomized, Controlled Trials
vs Warfarin
Ariel Dogliotti, Ernesto Paolasso, Robert P. Giugliano. Clin. Cardiol. 36, 2, 61–67 (2013)
40.
To assess the relative benefit of new oral
anticoagulants in key subgroups
And to assess the effects on important secondary
outcomes.
Aim
41.
Search: Medline from Jan 1, 2009, to Nov 19, 2013
Limited to phase 3, RCTs of patients with atrial fibrillation
who were randomised to receive new oral anticoagulants
or warfarin, and
Trials in which both efficacy and safety outcomes were
reported for their comparison
Study selection
42.
Pre specified analysis of the four phase 3 randomised trials
ROCKET AF
ARISTOTLE
RE LY
ENGAGE AF TIMI 48
Study selection
46.
1) Meta analysis done for both higher doses (dabigatran 150
mg bd and edoxaban 60 mg od) combined with the single
doses studied in ROCKET AF(rivaroxaban 20 mg od) and
ARISTOTLE(apixaban 5 mg bd)
2) In a separate analysis a meta-analysis of the two lower
doses (dabigatran 110 mg bd and edoxaban 30 mg od)
Statistical Analysis
47.
Statistical Analysis
Two sensitivity analyses were also done:
1) A meta-analysis of only the factor Xa inhibitors, with
removal of the thrombin inhibitor dabigatran
2) An analysis combining all doses of all drugs (both high
and low doses of dabigatran and edoxaban with
rivaroxaban and apixaban)
51.
Age (<75 vs ≥75 years)
Sex
H/O previous stroke or
TIA,
H/O diabetes,
Renal function (creatinine
clearance <50 ml/min, 50–
80 ml/min, >80 ml/min),
CHADS2 risk score (0–1, 2,
3–6),
VKA status at study entry
(naive or experienced), and
Centre-based time in
therapeutic range (threshold
of <66% vs ≥66%)
Subgroup analysis
Compared efficacy and safety in important clinical subgroups
54.
Stroke and systemic embolic events were significantly
reduced in patients receiving new oral anticoagulants.
This benefit was mainly driven by substantial protection
against haemorrhagic stroke, which was reduced by half
Significant reduction in all cause-mortality compared with
warfarin
Discussion
55.
For the prevention of ischaemic stroke, the new oral
anticoagulants had similar efficacy to warfarin
Reduced ischaemic stroke by two-thirds compared with placebo
Low dose regimen have a similar efficacy to warfarin for
protection against all stroke or systemic embolic events.
However, they are not as effective for protection against
ischaemic stroke in particular
Discussion
56.
Favourable safety profile compared with warfarin
However, they were associated with an increase in
gastrointestinal bleeding
Low dose regimen have a safer profile than warfarin
Consequently, they might be an appealing option for frail
patients or for those who have a high risk for bleeding with
full-dose anticoagulation
Discussion
57.
Statistical heterogeneity across the trials-complete
uniformity can show consistency in bias rather than
consistency in real effects, so some heterogeneity is
expected
Data from only clinical trials, which could affect the
generalisability of the results- results of phase 4
surviellance
Potential Limitations
59. 1. Is this article from a peer reviewed
journal?
Yes(go on) No(stop)
2. Is the location of the study similar to
mine so the results, if valid, apply to
my practice?
Yes(go on) No(stop)
3. Is the study sponsored by an
organization that may influence the
study design or results?
Yes(pause) No(stop)
4. Will this information, if true, have a
direct impact on the health of my
patients, and is it something they will
care about?
Yes(go on) No(stop)
5. Is the problem addressed one that is
common to my practice, and is the
intervention Or test feasible and
available to me?
Yes(go on) No(stop)
6. Will this information , if true, will
require me to change my current
practice?
Yes(go on) No(stop)