Rivaroxaban is a direct oral anticoagulant (DOAC) approved as an important alternative to warfarin in patients with nonvalvular atrial fibrillation. We report the case of an 87-year-old man with past medical history of nonvalvular atrial fibrillation on rivaroxaban and recently started amiodarone for pulseless ventricular tachycardia who presented to our hospital with intermittent chest pain and was diagnosed with spontaneous hemopericardium causing cardiac tamponade. The culprit drugs were discontinued, and the patient was treated with emergent pericardiocentesis. Both rivaroxaban and amiodarone are substrates for the CYP3A4 hepatic pathway, and concomitant use can result in increased plasma rivaroxaban levels causing an increased propensity to bleeding. While most physicians are cognizant of the need for renal dosing of rivaroxaban, this article aims to increase awareness of its interactions with drugs that are also metabolized through the same hepatic CYP450 pathway.
As the burden of cardiovascular and cerebrovascular events continues to increase, emerging evidence supports the concept of plaque vulnerability as a strong marker of plaque rupture, and embolization. Qualitative assessment of the plaque can identify the degree of plaque instability. Ultrasound and computed tomography (CT) have emerged as safe and accurate techniques for the assessment of plaque vulnerability. Plaque features including but not limited to surface ulceration, large lipid core, thin fibrous cap (FC), intraplaque neovascularization and hemorrhage can be assessed and are linked to plaque instability.
Objectives: Patient reported outcomes (PRO) are becoming useful tools for collecting and generating evidence for new medical products to show improvements in health-related quality of life (HRQoL). Castration-Resistant Prostate Cancer (CRPC) is a chronic disease with high importance for patient HRQoL. The objective of this study was to review, analyze, and understand trends in the PRO instruments used in patients with CRPC. MethOds: A systematic literature search for CRPC randomized controlled trials (RCTs) with PROs endpoints was undertaken for the databases Pubmed, Embase, Biosis, Google Scholar, and Cochrane. Data was collected for the study size, interventions, year, PRO instrument, and results for PROs. Analysis was conducted to identify trends in commonly used PRO instruments and categorize results as positive, neutral or negative. Results: Ten RCTs with a total of 5,797 patients were identified. In these studies there were thirteen different PROs instruments were identified that were FACT-P, FACT-G, BPI-SF, EQC30, EQPR25, FLIC, SDS, SUF, PDA, IPDA, PROSQOLI, SF-36, and QOLM-P14. The most commonly used instrument were FACT-P (used in 4,297 patients) and EQC-30 (used in 1,091 patients). Six studies reported positive results with improvement in quality of life symptoms (QoL) versus comparator treatments. Fours studies reported results with deterioration in (QOL). Three studies reported improvement in pain scores. cOnclusiOns: Patients with CRPC have relatively longer survival and hence QoL is an important consideration for these patients. PRO instruments such as FACT-P and EQC-30 have been commonly used to generate evidence to show which therapies improve patient QoL. PCN152 imPaCt of ColoReCtal CaNCeR oN aCtivities of daily liviNg aNd dePRessioN Risk amoNg oldeR ameRiCaNs
A 1 -A 2 9 8 FE and RE methods. CONCLUSIONS: Cisplatin significantly increased the RR of nephrotoxicity compared to non-cisplatin regimens when SCr was used to screen patients for inclusion in clinical trials, but only showed a trend toward a smaller increase in RR when GFR was used. was analyzed. All patients diagnosed with colorectal cancer throughout the study period were identified using International Classification of Disease 9 th Revision Clinical Modification (ICD-9-CM) diagnosis codes 153.xx and 154.xx. Descriptive statistical analyses were performed using SAS v9.3 software. RESULTS: There were 62,200 diagnosed colorectal cancer patients in the VHA population during the study period. Major comorbidities for these colorectal cancer patients were hypertension (n=18,309, 29.44%) and diabetes (n=10,891, 17.51%). Other minor comorbidities included hyperlipidemia and benign neoplasm of the colon. Common treatments prescribed for colorectal cancer patients were simvastatin and omeprazole. Outpatient services were utilized by 99.71% of colorectal cancer patients, followed by pharmacy (91.94%) and inpatient visits (31.15%). Costs for outpatient ($10,637, standard deviation [SD]=$17,125), pharmacy ($2,704, SD=$9,773), and inpatient services ($16,032, SD=$53,078) contributed to follow-up health care expenditures. Out of all colorectal cancer patients, 7,596 (12.21%) had Occult Blood (Fecal) Test results, with an average test result of 96.37. CONCLUSIONS:Colorectal cancer treatment is complicated by the presence of both major and minor comorbidities. Further analysis in the context of complicated comorbid conditions is required to improve the overall burden of illness of colorectal cancer patients. OBJECTIVES:Evaluate the efficacy, safety and cost estimates of sorafenib compared to other therapeutic options for the treatment of metastatic renal cell carcinoma (mRCC). METHODS: Systematic reviews (SR) of clinical trials comparing sorafenib with other therapeutic options were searched in The Cochrane Library, Medline, Lilacs, Centre for Reviews and Dissemination and Tripdatabase. We also selected health technology assessments (HTA) reports. Monthly treatment costs of the inhibitors of vascular endothelial growth factor
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