The U.S. Food and Drug Administration approval of the use apixaban in patients with a creatinine clearance (CrCl) < 15 ml/minute or those receiving dialysis is based only on pharmacokinetic data as clinical trials excluded CrCl 25 serum concentration (SCr) > 2.5 mg/dl. Thus, objective this study was to evaluate safety effectiveness versus warfarin severe renal impairment.Retrospective, matched-cohort study.Community hospital.A total 146 adults who received at least one dose (73 patients)...

For over 50 years, warfarin was the only oral anticoagulant approved in United States. In 2011, Food and Drug Administration (FDA) rivaroxaban. Since its introduction, rivaroxaban has served as an alternative to minimize drug interactions avoid monitoring. The objective of this study evaluate appropriateness dosing, indication safety a community hospital identify areas for improvement use.This single-centre, retrospective review evaluated patients who received at least one dose between...

Objective. To determine factors predictive of student failure or poor performance on advanced pharmacy practice experiences (APPEs) at a single program. Methods. This retrospective cohort evaluated students entering the Doctor Pharmacy (PharmD) program from 2012-2014 St. Louis College Pharmacy. Students who received grade F for one more APPEs (failure group) were compared to all other (non-failure group). A secondary evaluation with C (poor performers) (non-poor performers). Data collected...

Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. The objective this study is to evaluate requirements in hospitalized patients, stratified by BMI.This retrospective review included two cohorts patients: cohort A (patients admitted with a therapeutic international normalized ratio (INR)) B (newly initiated during hospitalization). Exclusion criteria included: age under 18 years,...

Gabapentin, a γ-aminobutyric acid derivative, is used for the treatment of partial onset seizures, postherpetic neuralgia, diabetic neuropathy and host other neurological disorders.A 44-year-old woman with spinal stenosis was prescribed gabapentin pain. Two months after initiating therapy, she diagnosed new-onset non-ischaemic cardiomyopathy an ejection fraction 36% measured on transthoracic echocardiogram.A patient suspected gabapentin-induced reported. However, to date, therapy has not...

Background: Enoxaparin, a low-molecular-weight heparin approved for prophylaxis in patients at risk venous thromboembolism (VTE), offers several advantages compared with unfractionated (UFH). Enoxaparin is primarily excreted through renal elimination and currently not recommended receiving hemodialysis (HD) due to potential increased bleeding complications. To date, there are limited safety efficacy data supporting the use of enoxaparin this patient population VTE prophylaxis. Objective: The...

Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy clinical trials and guideline support, it hypothesized that may be underutilized due to negative outcomes the CAST trial adverse effects are less common than previously perceived.This retrospective chart review evaluated ⩾18 years initiated on for AF from August 2011 October 2016 by cardiology provider at study...

In 2013, the United States Food and Drug Administration (FDA) approved Kcentra® (CSL Behring GmbH, Kankakee, IL, USA), for urgent reversal of acquired coagulation factor deficiency induced by vitamin K antagonist therapy (e.g. warfarin) in adult patients with acute major bleeding or need surgery/invasive procedure. This four-factor prothrombin complex concentrate (4F-PCC) contains factors II, VII, IX, X, proteins C S, antithrombin III human albumin. The dose is expressed as units IX...

Background Sacubitril/valsartan has been incorporated into guidelines based on the results of PARADIGM-HF trial, which demonstrated reduced mortality in stable patients with heart failure ejection fraction (HFrEF). is recommended addition to other HF therapies place an angiotensin-converting-enzyme inhibitor or angiotensin-receptor-blocker.Objectives To evaluate safety and tolerability sacubitril/valsartan initiation a community hospital.Design/methods This single-center, retrospective...

Background: Apixaban, a direct factor Xa inhibitor, is approved by the US Food and Drug Administration (FDA) for prevention of stroke systemic embolism in nonvalvular atrial fibrillation. Apixaban’s compelling safety efficacy data, combined with minimal laboratory monitoring, make it an attractive anticoagulant. Objectives: To characterize evaluate dosing apixaban treatment fibrillation at community hospital. Design/Patients: A retrospective chart review evaluated patients ≥18 years age who...

To evaluate the efficacy and safety of clevidipine (CLV) versus sodium nitroprusside (SNP) for treatment hypertension (HTN) in postoperative cardiac surgery patients at a community hospital.This single-center, retrospective, cohort study included treated with CLV or SNP systolic blood pressure (SBP) control. The primary outcome was defined as mean number times SBP rose above 140 mm Hg. Secondary outcomes comparative cost analysis analysis.Forty were each arm. Patients who received had higher...

Introduction The Appraisal of Guidelines, Research, and Evaluation version II (AGREE II) tool is a validated instrument designed to assess the methodological rigor transparency clinical practice guidelines. Objective primary objective this study was determine quality guidelines which pharmacists are indexed as an intended user using AGREE II. Methods used for in systematic evaluation. National Guideline Clearinghouse identify published from 2010 2016, focused on treatment, potential users....

What is known and objective Current guidelines recommend catheter ablation (CA) for atrial fibrillation (AF) refractory to at least one antiarrhythmic drug (AAD), but do not specify an adequate number of AADs be trialed prior considering ablation. The this study was evaluate the effect CA success based on failed in patients with paroxysmal or persistent AF. Methods This retrospective cohort evaluated AF who underwent initial a community hospital. Patients unknown AAD histories, those did...

Objective: To evaluate the risks and benefits of extended-duration thromboprophylaxis (EDT) beyond hospitalization in acutely ill medical patients. Data Sources: PubMed was searched from inception (1946) through February 2015 for search terms venous thrombosis/prevention control, thromboembolism/prevention anticoagulants, aspirin. Study Selection Extraction: Relevant clinical trials evaluating pharmacologic strategies EDT were screened inclusion. Bibliographies articles extensively reviewed...

Objective: To compare the safety and efficacy of neutral protamine Hagedorn (NPH) insulin to other antidiabetic regimens in treatment corticosteroid-induced hyperglycemia non-critically ill; hospitalized patients. Methods:This retrospective cohort included patients treated with methylprednisolone or prednisone concomitantly NPH medications for at least two days.Patients were screened inclusion reverse chronological order matched based on gender; age; body mass index; steroid dose; history...

Background: Guidelines recommend antithrombotic therapy in patients with nonvalvular atrial fibrillation (NVAF) to reduce the risk of stroke and systemic embolism (SSE) based on an assessment utilizing CHA 2 DS -VASc score. However, a treatment gap exists regarding at for thromboembolic events. Objectives: The aim this study was characterize use guideline-directed medical (GDMT) SSE NVAF upon hospital discharge. Methods: This retrospective review evaluated admitted community 2016. All were...

Curricular models that merge biomedical and/or pharmaceutical sciences with clinical are being increasingly employed across schools of pharmacy and other health professions the goal to promote integrative learning among students. Integrated Pharmacotherapy (IP): Cardiology is one 12 courses in IP series taught Doctor Pharmacy program at St. Louis College designed prepare student pharmacists care for patients by integrating pathophysiology, pharmacology, medicinal chemistry therapeutics....