The long term anticoagulation with warfarin is associated with various bleeding risks which led to the need for newer drugs. With the developments in the anticoagulation therapy the newer agents like dabigatran, rivaroxaba, apixaban and edoxaban have gained popularity with their more predictable pharmacological properties and reduced need for drug monitoring.The United States of America has approved both rivaroxaban and dabigatran to be used in the treatment of VTE (Venous Thrombo Embolism). In Europe and Canada dabigatran is prescribed after elective hip or knee arthroplasty to prevent VTE. For a VTE prophylaxis after an orthopediac surgery and to prevent stroke in AF patient, Rivaroxaban is recommended according to RECORD study. Edoxaban is highly effective in treatment of VTE and acts as a preventive measure of stroke in NVAF (Nonvalvular Atrial Fibrillation). Through this article various pharmacological aspects, dosing regimens, bleeding associated risk will be illustrated.
Ionizing radiotherapy is a very common treatment modality for various types of cancer. However, its uses are expected to increase drastically with several advances in screening as well as early detection of cancer. Radiation injury due to radiation to the gastrointestinal tract is an imperative factor that works against better utility of this critical treatment modality. Moreover, following radiotherapy there are a higher chances of acute as well as chronic symptoms that would significantly reduce the quality of life of patients and furthermore adding an extra burden to the patients in terms of cost of healthcare. Thus interventions to reduce these adverse events can have long term benefits. Acute radiation induced gastrointestinal adverse events can be managed by modification of diet. Dietary modification of fat, lactose or non-starch polysaccharides (fibre) or combination of these dietary modifications reduces acute gastrointestinal adverse events during radiotherapy. In our study, we observed patients diagnosed with prostate and rectal cancer and those patients receiving neo adjuvant chemo-radiotherapy of rectum. The patients were advised to follow certain dietary modifications which aid in controlling the acute gastrointestinal side effects that developed after exposing to radiation therapy. The patients were followed up on a weekly basis and recorded the severity of the gastro intestinal symptoms after each cycle of radiation therapy and the quality of life was also calculated. Our study demonstrates that the dietary intervention appears to be a promising treatment option to control these adverse events. The dietary restriction of fat, fibre and lactose also helped in reducing the grades of adverse events during the radiotherapy. The Quality of Life of patients, however, after radiotherapy was found to be decreased when compared to the baseline.
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