The Wall Street Journal began the week by publishing a provocative essay in which a young man suggested Obamacare kept his mother from getting appropriate medicine for her cancer. The writer crafted a poignant story about his mother, who sounds like a good person with a bad disease. Mainstream media buzzes with these types of stories. […]
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Elisabeth Rosenthal, a reporter with the New York Times, is doing American doctors a favor. Her series, Paying Till it Hurts, is forcing us to face our role in the US healthcare problem. That’s a good thing, because, as it goes in the practice of Medicine, the first step to achieving good outcomes is identifying […]
For the prevention of stroke in atrial fibrillation, the novel anticoagulant drugs dabigatran (Pradaxa, Boehringer Ingelheim), rivaroxaban (Xarelto, Bayer Pharma/Janssen Pharmaceuticals), apixaban (Eliquis, Pfizer/Bristol-Myers Squibb), and edoxaban (Lixiana, Daiichi-Sankyo) have been sold as both superior and more convenient than warfarin. But is this true? More than 60,000 patients have been enrolled in randomized controlled clinical […]
I made a discovery this week about the novel anticoagulant medications, dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Lixiana). I was looking into the often-asked question of how these new drugs compare to the old standard, warfarin. The discovery felt like a Eureka moment. I ran it by my stats guy–my son–and a couple […]
It’s time to do an update on the treatment of atrial fibrillation. It’s been a while, and there are worthy things to report from the real world. Stroke prevention in AF: Always start with basics: The most important aspect of treating atrial fibrillation is preventing stroke. Although there are some innovative devices and procedures in […]
The ultimate goal in medicine: protect the patient from stroke. Even a heart doctor has to admit the dominance of the human brain. Always think about preventing stroke. It’s one of the worst outcomes that can happen to a person. Life as a ‘normal’ human requires a healthy brain. A stroke irreversibly kills off part […]
You may find this hard to believe but I really don’t look at my site’s stats much. In fact, just today I discovered that WordPress has a feature that ranks posts by views. I’m not going to give you my Top Ten just by ranking. Rather, I’ll mix in some of my favorites and those […]
Yesterday afternoon, the FDA finally approved apixaban (Eliquis) for the prevention of stroke in patients with non-valvular atrial fibrillation. I use the words ‘finally approved’ because the markedly positive ARISTOTLE trial was published 15 months ago in the New England Journal of Medicine. The long delay was mysterious. On paper, apixaban looks to be the […]
For 57 years, doctors and patients have eagerly awaited an adequate substitute for the maligned blood thinner, warfarin. Now they are here. Boy are they ever. There has been oodles written about the new blood thinners, dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (soon to be Eliquis). As you might expect, thinning the blood with a […]
Let’s get off cell biology and back to something I really know. Atrial fibrillation, AF ablation and blood thinners. There was an important study published today in the Journal of the American College of Cardiology concerning the use of the new blood thinner, dabigatran (Pradaxa), around the time of AF ablation. A very concise overview, […]
You may have heard that AF is a tough disease to understand. Questions far outnumber answers. What causes AF? Why do some not feel it at all, while others are incapacitated? What’s the best treatment? Drugs? Ablation? Surgery? No treatment? Should I take a blood thinner…and which one? Where should one go for the best […]