I just answered a question the other day about a pt who was on an anticoagulant and whether he needed to be bridged prior to a procedure.

Now I have a pt who is on warfarin for AFib and who will be going for a psoas abscess draiange. So I'm holding his warfarin. He needs to be bridged based on his CHADSVASc score being 2, meaning high risk for thromboembolism. From UpToDate:

Atrial fibrillation (to prevent stroke and systemic embolism): Note: When admitted for short-term hospitalization (eg, admission for a procedure or surgery), ambulatory patients taking an oral anticoagulant and not at high risk of immediate thromboembolism typically do not require bridging anticoagulation. Patients at high risk of thromboembolism (eg, recent cardioversion, high CHA2DS2-VASc score, prior cardioembolic stroke, current intracardiac thrombus) may be considered for bridging with a parenteral anticoagulant (see Transitioning between anticoagulants below).

Transitioning between anticoagulants: Note: This provides general guidance on transitioning between anticoagulants; also refer to local protocol for additional detail.

Transitioning from another anticoagulant to IV heparin:

Transitioning from a therapeutic dose of SUBQ low-molecular-weight heparin or SUBQ fondaparinux to a therapeutic dose of IV heparin: Start IV heparin without a bolus dose (infusion rate depends on the indication) 1 to 2 hours before the next dose of low-molecular-weight heparin (LMWH) or fondaparinux would have been due (Ref).

Transitioning from warfarin to a therapeutic dose of IV heparin: Stop warfarin and, when INR is as close as possible to the lower end of the targeted INR range, start IV heparin without a bolus dose (infusion rate depends on the indication) (Ref).

Transitioning from a direct-acting oral anticoagulant to a therapeutic dose of IV heparin: Stop direct-acting oral anticoagulant (DOAC) and, when the next DOAC dose would have been due, start IV heparin without a bolus dose (infusion rate depends on the indication) (Ref).

Transitioning from IV heparin to another anticoagulant:

Transitioning from a therapeutic dose of IV heparin to therapeutic SUBQ low-molecular-weight heparin or SUBQ fondaparinux: Stop IV heparin and within 1 hour start SUBQ LMWH or SUBQ fondaparinux. Note: If aPTT is not within therapeutic range at the time heparin is stopped, consult local protocol (Ref).

Transitioning from a therapeutic dose of IV heparin to warfarin: Start warfarin and continue IV heparin until INR is within therapeutic range (Dager 2018; Hull 2022a). Note: Overlap IV heparin with warfarin until INR is ≥2 for at least 2 measurements taken ~24 hours apart (duration of overlap is ~5 days) (Ref).

Transitioning from a therapeutic dose of IV heparin to a direct-acting oral anticoagulant: Start DOAC when the heparin infusion is stopped (consult local protocol if the aPTT is above the target range) (Ref).

So I'm gonna hold warfarin and check his INR. Day team can start the heparin.

Cardinals DE JJ Watt gets emotional in his postgame presser after revealing he went into A-Fib and had to get his heart shocked back into rhythm last Thursday.

IG: azcardinals (10/2/22)

Cardioversion with posterior/anterior pads

My mom's back at the hospital with afib again, but this time it seems to have been brought on by covid, which they now think she has, so they are treating for covid.

30 freakin days. So happy to be done with my heart monitor. Nothing says “what the eff is wrong with you?” Then an electronic device attached to your chest. I may go swimming today just because I don’t have to worry about it. 😎😬 Yes I’m still in bed. I’m also grateful for modern medicine. Two weeks until ablation. ❤️ #afib #rude #noreason #makesmefeelold #windedanddizzy https://www.instagram.com/p/Cfww5cAPoR4CU7Djio7XHmVu0bcPotYosYgVmE0/?igshid=NGJjMDIxMWI=

AFIB Struggles Despite Revenue Surge in Q4 2023 - Will Profitability Ever Come? https://csimarket.com/news/earnings/afib_struggles_despite_revenue_surge_in_q4_2023_-_will_profitability_ever_come_2024-04-03102036?utm_source=dlvr.it&utm_medium=tumblr

middle finger to ...

I lost my state backed healthcare thanks to the luxury of making a little more than the state considers "poverty." Honestly, it was a long time coming but initially they laid off cutting people off due to covid. But now... that "covid is over"... it's time to cut the fat loose.

*eye roll*

In the State of Cali, where rent is above average batshit and gas is $5 a gallon, the state says $1,677 a month and below is poverty. And that's god damned right. That's the min you could get a shoebox to rent for and then there'd be literally nothing left for groceries, transit fuel, automobile upkeep.... or even a fucking car tbh, communication and internet, medication, sanitary care, job training, utilities, kids and/or pets, and the ever beloved avocado toast all the boomers love to complain about.

I now make enough for rent AND groceries so that means I don't deserve to take care of my health. And every boomer grinned in approval.

All jokes aside I am trying to find health insurance because I can't be off of it. I have hopefully benign tumors in my uterus from this past year. A currently benign titty tumor that needs monitoring. My heart is probably due for another halter monitor since covid fucked it up - and now there's a chance I'm borderline afib. Before, the cardiologist was like "It'S nO bIg DeAl. It'S jUsT PVCs." Except it's constant. And takes the wind out of my chest. So there's that. How is that jUsT pVcS? Then I have major inflammatory issues going on internally that require awful oscopy monitoring. In short, I have a combo of PTSD induced illnesses AND post-viral chronic syndrome and together these two umbrellas of hell are borderlining autoimmune illness x 3.

So no, I can't NOT have health insurance. Not an option. I'm just struggling and overwhelmed in picking something that isn't going to bankrupt me because every option is bat shit expensive, (just like rent), and then you get nothing for it. Just the "privelege" of having a $6,000 max. Like, what the fuck? At least I get a guaranteed roof over my head for the price of rent.

Can we set insurance execs homes on fire, please? And while we're at let's come for the hospital executives and greedy ass doctor's groups too. It's time for a great reset.

Aspirus to offer free seminar on atrial fibrillation

Registration is required.

WAUSAU – Aspirus Heart Care will offer a free seminar on atrial fibrillation its risks and innovative treatment options offered at Aspirus Heart Care. Atrial fibrillation, the most common heart condition, is estimated to affect over 2.5 million Americans. AFib is a heart rhythm disorder that causes the heart to beat irregularly, greatly increasing the risk of stroke and congestive heart…

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Anyone have experience with these? I need to know how to sleep without waking up with a sore chest lmao.

You have to decrease the dose of Eliquis if pt is less than 60 kg, over 80 y/o, has reduced renal function. A mnemonic is ABCD, Age greater than or equal to 80, Body weight less than or equal to 60 kg, creatinine greater than or equal to 1.5, Double of these factors. Halve dose to 2,5 mg bid.

International experts discuss how patients with atrial fibrillation can live longer and better lives

Recent advances in the diagnosis and treatment of atrial fibrillation, and what they mean for patients, were considered by a group of around 75 international experts at a three-day meeting. Photo by Karolina Grabowska on Pexels.com The 9th biannual Consensus Conference of the German Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA), a branch of the European…

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Heart Rhythms and Dementia — Dr. Michael Hunter's Wellness

ATRIAL FIBRILLATION — THE MOST COMMON ARRHYTHMIA TYPE — is associated with a modest increase in dementia risk. This heightened risk is present whether or not the atrial fibrillation caused a stroke. 1,061 more words Heart Rhythms and Dementia — Dr. Michael Hunter’s Wellness

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