clinical pharmacy and pharmacology

Importance: Data from randomized clinical trials on a long-term anticoagulation strategy for patients after catheter-based ablation for atrial fibrillation (AF) are lacking.

Objective: To evaluate whether discontinuing oral anticoagulant therapy provides superior clinical outcomes compared with continuing oral anticoagulant therapy in patients without documented atrial arrhythmia recurrence after catheter ablation for AF.

Design, setting, and participants: A randomized clinical trial including 840 adult patients (aged 19-80 years) who were enrolled and randomized from July 28, 2020, to March 9, 2023, at 18 hospitals in South Korea. Enrolled patients had at least 1 non-sex-related stroke risk factor (determined using the CHA2DS2-VASc score [range, 0-9]) and no documented recurrence of atrial arrhythmia for at least 1 year after catheter ablation for AF. The CHA2DS2-VASc score is used as an assessment of stroke risk among patients with AF (calculated using point values for congestive heart failure, hypertension, ≥75 years of age, diabetes, stroke or transient ischemic attack, vascular disease, between 65 and 74 years of age, and sex category). The date of final follow-up was June 4, 2025.

Interventions: The patients were randomly assigned in a 1:1 ratio to discontinue oral anticoagulant therapy (n = 417) or continue oral anticoagulant therapy (with direct oral anticoagulants; n = 423).

Main outcomes and measures: The primary outcome was the first occurrence of a composite of stroke, systemic embolism, and major bleeding at 2 years. Individual components of the primary outcome (such as ischemic stroke and major bleeding) were assessed as secondary outcomes.

Results: Of the 840 adults randomized, the mean age was 64 (SD, 8) years, 24.9% were women, the mean CHA2DS2-VASc score was 2.1 (SD, 1.0), and 67.6% had paroxysmal AF. At 2 years, the primary outcome occurred in 1 patient (0.3%) in the discontinue oral anticoagulant therapy group vs 8 patients (2.2%) in the continue oral anticoagulant therapy group (absolute difference, -1.9 percentage points [95% CI, -3.5 to -0.3]; P = .02). The 2-year cumulative incidence of ischemic stroke was 0.3% in the discontinue oral anticoagulant therapy group vs 0.8% in the continue oral anticoagulant therapy group (absolute difference, -0.5 percentage points [95% CI, -1.6 to 0.6]). Major bleeding occurred in 0 patients in the discontinue oral anticoagulant therapy group vs 5 patients (1.4%) in the continue oral anticoagulant therapy group (absolute difference, -1.4 percentage points [95% CI, -2.6 to -0.2]).

Conclusions and relevance: Among patients without documented atrial arrhythmia recurrence after catheter ablation for AF, discontinuing oral anticoagulant therapy resulted in a lower risk for the composite outcome of stroke, systemic embolism, and major bleeding vs continuing direct oral anticoagulant therapy.

Trial registration: ClinicalTrials.gov Identifier: NCT04432220.

Author/s:

Daehoon Kim, MD, Jaemin Shim, MD, Eue-Keun Choi, MD

Strategies to Help Patients Afford Their Medicines in the US

Erin Blanchette — Mon, 28 Oct 2024 14:04:14 +0000

Date Added:

October 28, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

October 21, 2024

URL:

Strategies to Help Patients Afford Their Medicines in the US

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2024.21143

Keywords

clinical pharmacy and pharmacology

Patient Information

jama Patient Information

Health Care Economics, Insurance, Payment

insurance

PMID (1):

39432270

MeSH

A concise summary for patients about ways to reduce the cost of expensive medications. James W. Mold, MD, MPH

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Many patients in the US struggle to afford their prescription drugs. The inability to take medications as prescribed can lead to worse health outcomes.

Below are 7 strategies that patients can use to respond to high prescription drug costs in the US.

Author/s:

Kristin L Walter

Nonprescription Medications for Eye Allergies

Erin Blanchette — Sun, 04 Feb 2024 22:00:14 +0000

Date Added:

February 4, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

January 19, 2024

URL:

Nonprescription Medications for Eye Allergies

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.20168

Keywords

allergy and clinical immunology

Allergy Prevention

clinical pharmacy and pharmacology

eyes

eye allergies

PMID (1):

38241037

MeSH

Conjunctivitis, Allergic

eye pain

Dry Eye Syndromes

Information for patients about OTC eye drops for allergies. James W. Mold, MD, MPH

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This JAMA Patient Page describes the types of over-the-counter medications to treat eye allergy symptoms and how to use them.

Author/s:

Sarah E Vordenberg

Topical Nonprescription Pain Medications for Adults

Erin Blanchette — Tue, 14 Nov 2023 20:48:41 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

November 3, 2023

URL:

Topical Nonprescription Pain Medications for Adults

Type:

Patient Education Materials

Format:

Article

DOI (1):

doi:10.1001/jama.2023.13813

Keywords

clinical pharmacy and pharmacology

PMID (1):

37921785

MeSH

Anti-Inflammatory Agents

Anti-Inflammatory Agents, Non-Steroidal

Nonprescription Drugs

Information for patients on three types of nonprescription topical analgesics. James W. Mold, MD, MPH

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This JAMA Patient Page describes the types of topical nonprescription pain medications and tips for using them.

Topical nonprescription pain medications are over-the-counter drugs applied to the skin to treat pain.

Topical pain medications can effectively treat pain caused by several acute and chronic conditions. Because they are applied directly to the skin, topical pain medications are easy to use and less likely to cause side effects or interact with other medications than oral pain medications. Pain relief typically occurs within several days of starting a topical pain medication.

Author/s:

Sarah E. Vordenberg