Most Read Articles
Audrey Abella, 15 May 2020
In adults with atrial fibrillation (AF) after percutaneous coronary intervention (PCI), dual therapy (direct oral anticoagulant [DOAC] + P2Y12 inhibitor) reduces the risk of bleeding compared with triple therapy (vitamin K antagonist [VKA] + DAPT* [aspirin and P2Y12 inhibitor]), a meta-analysis has shown. However, its effects on the risks of mortality and ischaemic endpoints** remain unclear.
09 May 2020
Use of aspirin during the implantation window of the menstrual cycle appears to increase fecundability, reveals a recent study.
Rachel Soon, 08 Apr 2020

Guidelines for local pharmacists on what actions to take during the COVID-19 pandemic have been issued by the Malaysian Pharmaceutical Society (MPS).

Pearl Toh, 26 Sep 2019
The Singapore Health Sciences Authority (HSA) has recalled eight brands of ranitidine products containing trace amounts of the nitrosamine impurity NDMA*, which is a potential human carcinogen.

BPVT patients on warfarin at risk of recurrence, prosthetic degeneration

02 Mar 2020
The story of warfarin: From cattle killer to rat poison to humanity’s most cherished drug

A significant number of patients treated with anticoagulation for bioprosthetic valve thrombosis (BPVT) are in danger of recurrence and early prosthetic degeneration, a study has shown.

This matched-cohort analysis aimed to determine the long-term outcomes of patients with BPVT treated with anticoagulation. The authors included 83 patients (mean age, 57±18 years; 54 percent male) who received warfarin for suspected BPVT at the Mayo Clinic between 1999 and 2017. Participants were then matched to 166 controls according to age, sex, year of implantation, prosthesis type and position.

Of the patients, 62 (75 percent) had normalized echocardiography within 3 months (interquartile range [IQR], 1.5–6 months) of anticoagulation and 21 (25 percent) did not respond to treatment. Median follow-up after diagnosis was 34 months (IQR, 17–54 months).

Long-term outcomes were comparable between patients with BPVT and matched controls (log-ran test, p=0.79), but the former had a significantly higher rate of major bleeding (12 percent vs 2 percent; p<0.0001). After a median of 23 months (IQR, 11–39 months), 14 (23 percent) responders had a BPVT recurrence (re-BPVT). Of these, only one re-BPVT patient did not respond to anticoagulant therapy.

In addition, patients with BPVT were more likely to have a valve re-replacement than controls (68 percent vs 24 percent at 10 years post-BPVT; log-rank test, p<0.001).

“Indefinite warfarin anticoagulation should be considered after a confirmed BPVT episode, but this strategy must be balanced against an increased risk of bleeding,” the authors said.

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Most Read Articles
Audrey Abella, 15 May 2020
In adults with atrial fibrillation (AF) after percutaneous coronary intervention (PCI), dual therapy (direct oral anticoagulant [DOAC] + P2Y12 inhibitor) reduces the risk of bleeding compared with triple therapy (vitamin K antagonist [VKA] + DAPT* [aspirin and P2Y12 inhibitor]), a meta-analysis has shown. However, its effects on the risks of mortality and ischaemic endpoints** remain unclear.
09 May 2020
Use of aspirin during the implantation window of the menstrual cycle appears to increase fecundability, reveals a recent study.
Rachel Soon, 08 Apr 2020

Guidelines for local pharmacists on what actions to take during the COVID-19 pandemic have been issued by the Malaysian Pharmaceutical Society (MPS).

Pearl Toh, 26 Sep 2019
The Singapore Health Sciences Authority (HSA) has recalled eight brands of ranitidine products containing trace amounts of the nitrosamine impurity NDMA*, which is a potential human carcinogen.