Rivaroxaban:Xarelto® - Recommendations for pharmacists

Rivaroxaban is one of the new oral anticoagulants (NOACs) (recommended as reference treatments when a long-term anticoagulation is needed). It has many potential advantages in comparison with Vitamin K Antagonists (VKA). It has a predictable anticoagulant effect and does not theoretically require biological monitoring. It is also characterized by less food and drug interactions. However, due to major risks associated with over- and under-dosage, its optimal use in patients should be carefully followed by health care professionals. The aim of this article is to provide recommendations for pharmacists on the practical use of Xarelto® in its different approved indications. This document is adapted from the practical user guide of rivaroxaban which was developed by an independent group of Belgian experts in the field of thrombosis and haemostasis

Is a cooled tip catheter the solution for the ablation of the cavotricuspid isthmus?

To test the theoretical superiority of irrigated tip catheters to achieve complete cavotricuspid isthmus block, a 4-mm cooled tip catheter was compared to a conventional 8-mm tip catheter with a double temperature sensor in the cavotricuspid isthmus (CTI) ablation. The study prospectively enrolled 60 patients (47 men, mean 65 +/- 10 years) with common flutter divided in group 1 (n = 30) assigned to an 8-mm tip catheter versus group 2 (n = 30), assigned to an internal circuit, irrigated tip catheter. Linear radiofrequency applications were performed in a point-by-point protocol to achieve complete CTI block. Complete CTI block was achieved in 29 patients in each group. Mean durations of procedure and fluoroscopy were 91 versus 90 and 40 versus 33 minutes in group 1 versus 2, respectively, (NS). The mean number/patient of RF pulses to interrupt atrial flutter was four in group 1 and eight in group 2 (P = 0.034), and 11 and 13, respectively, to interrupt CTI conduction (NS). The total energy delivered was similar in both groups (29,237 vs 23,236 W/s, NS). CTI ablation with a conventional 8-mm tip catheter versus an irrigated tip catheter was associated with similar success rates, procedure duration, and fluoroscopic exposure. The technical complexity of the cooled tip catheter renders it less competitive

Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?

Frédéric Maes,1,* Olivia Dalleur,2,3,* Séverine Henrard,4 Dominique Wouters,2 Christophe Scavée,1 Anne Spinewine,3,5 Benoit Boland4,6 1Cardiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; 2Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; 3Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; 4Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium; 5Pharmacy Department, CHU Dinant-Godinne, Université catholique de Louvain, Yvoir, Belgium; 6Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium *The first two authors have contributed equally to the work Objectives: Anticoagulation for the prevention of cardio-embolism is most frequently indicated but largely underused in frail older patients with atrial fibrillation (AF). This study aimed at identifying characteristics associated with anticoagulation underuse.Methods: A cross-sectional study of consecutive geriatric patients aged ≥75 years, with AF and clear anticoagulation indication (CHADS2 [Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack] ≥2) upon hospital admission. All patients benefited from a comprehensive geriatric assessment. Their risks of stroke and bleeding were predicted using CHADS2 and HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older (age >75 years), Reduced platelet count or function, Rebleed risk, Hypertension (uncontrolled), Anemia, Genetic factors, Excessive fall risk, and Stroke) scores, respectively. Results: Anticoagulation underuse was observed in 384 (50%) of 773 geriatric patients with AF (median age 85 years; female 57%, cognitive disorder 33%, nursing home 20%). No geriatric characteristic was found to be associated with anticoagulation underuse. Conversely, anticoagulation underuse was markedly increased in the patients treated with aspirin (odds ratio [OR] [95% confidence interval]: 5.3 [3.8; 7.5]). Other independent predictors of anticoagulation underuse were ethanol abuse (OR: 4.0 [1.4; 13.3]) and age ≥90 years (OR: 2.0 [1.2; 3.4]). Anticoagulation underuse was not inferior in patients with a lower bleeding risk and/or a higher stroke risk and underuse was surprisingly not inferior either in the AF patients who had previously had a stroke. Conclusion: Half of this geriatric population did not receive any anticoagulation despite a clear indication, regardless of their individual bleeding or stroke risks. Aspirin use is the main characteristic associated with anticoagulation underuse. Keywords: atrial fibrillation, anticoagulation, antiplatelet therapy, geriatric medicine, under-prescribin

Influence of respiratory cycle on proximal renal artery motion: an angiographic study in patients undergoing endovascular aneurysm repair.

The purpose of our study was to evaluate the influence of respiratory cycle on proximal renal artery (RA) motion in twenty consecutive patients with abdominal aneurysm and the potential impact on endograft deployment during endovascular aneurysm repair (EVAR).info:eu-repo/semantics/publishe