To review the use of the novel oral anticoagulant (NOAC) agents for the treatment of heparin-induced thrombocytopenia (HIT) from relevant clinical trial data. A MEDLINE, International Pharmaceutical Abstracts, ClinicalTrials.gov, and Google-Scholar searches (1966-March 2016) were conducted using the keywords: thrombocytopenia, NOACs, dabigatran, apixaban, rivaroxaban, edoxaban, Xa inhibitor, direct thrombin inhibitor. Articles evaluating the new oral anticoagulants for thrombocytopenia published in English and using human subjects were selected. Eight clinical trials were identified. References cited in identified articles were used for additional citations. Approximately 12 million hospitalized patients each year are exposed to heparin for thromboprophylaxis. HIT, an immune-mediated, prothrombotic adverse reaction is a potential complication of heparin therapy. As a result, heparin products must be immediately withdrawn and replaced by alternative anticoagulants to compensate for the thrombotic risk associated with HIT. Limitations exist with the only currently FDA approved heparin alternative, argatroban. NOACs have been considered as potential alternatives to traditional agents based on their pharmacologic activity. Case reports have indicated positive results in patients, with clinical outcomes and tolerability supporting the use of the NOACs as alternative agents in the treatment of HIT. Positive results have been reported for the use of NOACs in the treatment of HIT. Further robust studies are needed for definitive decision making by clinicians.
Aerobic capacity (VO2peak ) testing equipment can be expensive. Garmin fitness watches are significantly cheaper, and Garmin has developed a fitness test that estimates VO 2peak . The purpose of this study was to validate the Garmin fitness test, using a Garmin Forerunner 920XT fitness watch, against VO 2peak measurement, using a Parvomedics TrueOne 2400 open circuit spirometry device. Sixteen college students (10 male and 6 female) volunteered to complete the Garmin fitness test followed several days later by a Bruce treadmill test while oxygen consumption was measured via open circuit spirometry. The average VO 2peak from the Garmin test was 45.4 (± 5.6) ml/kg/min, compared to 45.0 (± 8.9) ml/kg /min from open circuit spirometry. There were no significant differences between the measurements (t = 0.221 with p = 0.828). The two measurements were highly correlated with a correlation coefficient of 0.84 (p =0.000). The Garmin fitness test seems to be a highly accurate estimation of VO 2peak2peak.
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