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Old 03-04-2013
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Drug Warfarin alternative

A 76 year old obese woman with history of uncontrolled Hypertension and Type 2 Diabetes is evaluated in your office during a follow-up visit. She has history of atrial fibrillation and has been taking warfarin for stroke prevention. However, she has difficulty keeping up with her appointments for INR monitoring and does not wish to continue warfarin. Mini mental status examination reveals mild dementia. Get up and Go test does no show any increased risk of fall. She denies any active bleeding. Rest of her physical examination is unremarkable. Her INR is 1.3 and her previous INRs have been sub-therapeutic. Laboratory investigations including complete blood count, serum creatinine and liver function tests are within normal limits. Which of the following management options is most appropriate for this patient?

A) Aspirin alone
B) Aspirin and Dipyridamole
C) Reduced intensity warfarin
D) Low Molecular Weight Heparin
E) Dabigatran
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Old 03-04-2013
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i think its dabigatran
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stfidel (03-05-2013)
Old 03-05-2013
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Default E) Dabigatran

E) Dabigatran

dose dependent no need for INR mointoring
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E) Dabigatran

Dabigatran is an oral anticoagulant from the class of the direct thrombin inhibitors. It is used for various clinical indications, and in some cases it offers an alternative to warfarin as the preferred orally administered anticoagulant , since it does not require frequent blood tests for international normalized ratio monitoring, while offering similar results in terms of efficacy. No specific way exists to reverse the anticoagulant effect of dabigatran in the event of a major bleeding event,[2][3] unlike warfarin.[When the risk is significant and the INR cannot be maintained within the target range despite close monitoring, dabigatran is the alternative to warfarin, provided the patient is closely monitored, especially for changes in renal function,[8] adverse events (bleeding) and discontinuation.
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