Anti-coagulation

Xarelto: Now approved for DVT and PE – pro

  Xarelto (varoxaban, a factor Xa inhibitor) is the first oral anti-coagulant approved for anti-coagulation in 60 years, since Warfarin (coumadin) was approved. A variety of parenteral options are available; however, the oral route is preferred by many physicains and patients. In November 2012, the U.S. Food and Drug Administration expanded the approved use of Xarelto (rivaroxaban) to include treating deep vein thrombosis (DVT) or pulmonary

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Warfarin (coumadin) sensitivity test – pro

Warfarin (Coumadin®) dose is sometimes difficult to adjust. The labeling for a popular formulation of warfarin was revised in August 2007 and February 2010 to include information about how the three most widely studied pharmacogenetic mutations (CYP2C9*2, CYP2C9*3, and VKORC1 -1639G>A) affect dose requirements (NDA 9-218/S-105). The Warfarin-Sensitivity test idendifies that most common mutations that affect warfarin metabolism. CYP2C9 genotype

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Protein C for sepsis and fulminant purpura – pro

Protein C Concentrate (Human) is used for patients with severe congenital Protein C deficiency for the prevention and treatment of venous thrombosis (blood clot in the vein), and purpura fulminans (blood spots, bruising and discoloring to skin as a result of clotting of small blood vessels in the skin). CEPROTIN is indicated as a replacement therapy for pediatric and adult patients. There some preliminary support that Ceptrotin may be useful in prupura

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Flexitouch System for Lymphedema – pro

Lymphedema is condition that is difficult to treat. Flexotouch is a non-manual device. Guidelines on its appropriateness are discussed. Lymphedema pumps (pneumatic compression devices) are generally considered medically necessary for home use for the treatment of lymphedema if the member has undergone a four-week trial of conservative therapy and the treating doctor determines that there has been no significant improvement or if significant symptoms

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Hypercoagulability and homocystein – pro

Hypercoagulable states can be defined as a group of inherited or acquired conditions associated with a predisposition to venous thrombosis, arterial thrombosis, or both. Venous thromboembolic disease is the most common clinical manifestation resulting from hypercoagulable states. Among them is hyperhomocysteneimia. Hyperhomocysteinemia can be precipitated by both genetic defects and acquired medical conditions, including vitamin deficiency states.

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Home INR Testing – pro

Lay Summary: Home Prothrombin testing is becoming standard in many countries, but it is only now appearing in the USA. The literature shows that it is a reliable way of monitoring Coumadin therpay. Near-patient testing (NPT) is becoming increasingly common in some countries. In the United Kingdom, for example, near-patient testing is used both by patients at home, and by some anticoagulation clinics (often hospital-based) as a fast and convenient

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Anticoagulation in cancer patients – guidelines – pro

Pulmonary emboli is an indication for long term anticoagulation. Although generally oral warfarin is used, it is now recognized that it is not as effective in patients with thromboses secondary to cancer as are the low molecular weight heparins, such as Lovenox. Low Molecular Weight Heparins are used for the prophylaxis or treatment of deep vein thrombosis. The decision to use LMWH instead of standard heparin or warfarin will depend upon the clinical

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Avastin for soft-tissue sarcoma – pro

Drugs that block new blood vessel formation may help kill sarcomas by preventing their nourishment by the blood vessels. According to a recent article published in the Journal of Clinical Oncology, the addition of Avastin® (bevacizumab) to the chemotherapy agent Adriamycin® (doxorubicin) may slow cancer progression in patients with metastatic soft-tissue sarcomas. Bevacizumab (Avastin) has shown a small benefit in sarcoma patients, when given with

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Pradaxa – pro

Dabigatran (Pradaxa ) is an oral anticoagulant from the class of the direct thrombin inhibitors. It is oral and offers an alternative to warfarin. Unlike warfarin(Coumadin) it does not require frequent blood tests for international normalized ratio (INR) monitoring while offering similar results in terms of efficacy. On the other hand, there is no specific way to reverse the anticoagulant effect of dabigatran in the event of a major bleeding event,

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Generic versus proprietary Warfarin – pro

Whether generic and proprietary wrafarin is interchangeable has been investigated. Multiple n-of-1 randomized, double-blind, crossover trials switched outpatients (N = 7) between a generic warfarin formulation (Apo-warfarin) and Coumadin over 30 weeks. Study patients took each drug for five 3-week periods, with international normalized ratio (INR) measurements taken twice per period. Inter- and intrapatient differences between generic warfarin and

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