As dabigatran (Pradaxa) has recently been approved by the Food and Drug Administration, many spine specialists are not familiar with this agent. Many of the reversal agents (e.g., vitamin K and protamine), useful for other classes of anticoagulants, have no impact on Pradaxa. Similarly, prothrombin time and partial thromboplastin times have limited utility in estimating the patient's true clotting status. The purpose of this case report is to alert spine specialists to this drug and its implications on spine care. The drug's pharmacokinetics, clinical assessment of clotting status, and reversal options are discussed.
Acute pain intensity has conventionally been assessed with a patient self-reported, unidimensional pain scale. This approach can inadvertently underestimate analgesia and result in large cumulative opioid doses and greater dose-dependent side effects and complications. We have thus created the Therapeutic Activity Goal (TAG) as an alternate, more comprehensive way to assess acute postoperative pain, and even more so, to define and determine adequate postoperative analgesia. The TAG comprises the level of acceptable pain intensity, the level and types of desired activities, and accomplishing other patient-centered functional goals. The TAG evolves throughout the patient's hospitalization to promote timely discharge.
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