scholarly journals The effectiveness of split tablet dosing versus alternate-day dosing of warfarin: a randomized control trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chanyapat Kaewsaengeak ◽  
Usanee Pienputtarapong ◽  
Teerapong Tocharoenchok
Keyword(s):  
Therapeutic Range ◽  
Warfarin Dosage ◽  
Time In Therapeutic Range ◽  
Tablet Splitting ◽  
Group A ◽  
The Mean ◽  
Baseline Characteristics ◽  
Large Dosage ◽  
To Receive ◽  
Dose Change

AbstractDue to large dosage variation, a variety of warfarin prescription regimens are utilized for specific doses such as tablet splitting, or pill strength alternating. The clinical comparison between the two is lacking. We hypothesize that both approaches result in different times in therapeutic range. We randomized patients with specific warfarin dosage and stable INR for 6 months or longer to receive the whole tablet, alternate-day dosing or the split tablet, same daily-dosing regimen without initial dose change and followed them every 6 weeks for 6 months. The primary outcome was a time in therapeutic range of 2.0–3.0. The secondary outcomes included dosage, compliance, INR, anticoagulant-related events. A total of 66 patients were enrolled, 32 randomly assigned to the split tablet regimen (group S) and 34 to the alternate-day regimen (group A) with two withdrawers. The mean age was 58.6 ± 8.5 years. All baseline characteristics of both groups were similar. The average time in therapeutic range was 72.8 ± 25.4% in group S and 74.9 ± 22.0% in group A (p = 0.72). There were no significant differences in warfarin dosage, compliance, INR and, complications between the two groups. Both warfarin prescription methods, the split tablet and the alternate-day had comparable time in the therapeutic range.

scholarly journals The Effectiveness of Split Tablet Dosing Versus Alternate-Day Dosing of Warfarin: A Randomized Control Trial

2021 ◽  
Author(s):  
Chanyapat Kaewsaengeak ◽  
Usanee Pienputtarapong ◽  
Teerapong Tocharoenchok
Keyword(s):  
Therapeutic Range ◽  
Warfarin Dosage ◽  
Time In Therapeutic Range ◽  
Tablet Splitting ◽  
Group A ◽  
The Mean ◽  
Baseline Characteristics ◽  
Large Dosage ◽  
To Receive ◽  
Dose Change

Abstract Due to large dosage variation, a variety of warfarin prescription regimens are utilized for specific doses such as tablet splitting, or pill strength alternating. The clinical comparison between the two is lacking. We hypothesize that both approaches result in different times in therapeutic range. We randomized patients with specific warfarin dosage and stable INR for 6 months or longer to receive the whole tablet, alternate-day dosing or the split tablet, same daily-dosing regimen without initial dose change and followed them every 6 weeks for 6 months. The primary outcome was a time in therapeutic range of 2.0 to 3.0. The secondary outcomes included dosage, compliance, INR, anticoagulant-related events. A total of 66 patients were enrolled, 32 randomly assigned to the split tablet regimen (group S) and 34 to the alternate-day regimen (group A) with two withdrawals. The mean age was 58.6 ± 8.5 years. All baseline characteristics of both groups were similar. The average time in therapeutic range was 72.8 ± 25.4% in group S and 74.9 ± 22.0% in group A (p = 0.72). There were no significant differences in warfarin dosage, compliance, INR and, complications between the two groups. Both warfarin prescription methods, the split tablet and the alternate-day had comparable time in the therapeutic range.

scholarly journals A Double-Blind Randomized Prospective Study Comparing Ondansetron with Droperidol in the Prevention of Emesis following Strabismus Surgery

1995 ◽  
Vol 23 (4) ◽  
pp. 438-443 ◽  
Author(s):  
A. Davis ◽  
S. Krige ◽  
D. Moyes
Keyword(s):  
Recovery Time ◽  
Strabismus Surgery ◽  
Double Blind Study ◽  
Double Blind ◽  
Oral Fluids ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
To Receive ◽  
Mean Time

A prospective double-blind study was conducted to compare the anti-emetic efficacy of ondansetron and droperidol in preventing postoperative emesis following strabismus surgery. A sample size of 213 patients was divided into three equal groups to receive ondansetron 150 μg/kg (Group A), ondansetron 75 μg/kg (Group B), or droperidol 75 fig/kg (Group C). All patients received a standardized anaesthetic technique. All episodes of emesis, recovery time, and time to tolerating oral fluids were recorded. The incidence of emesis during 24 hours was Groups A and B 19.7%, and Group C 28.2%. The lower incidence of emesis recorded by the ondansetron groups compared with the droperidol group was not statistically significant. Ondansetron at 75 μg/kg was as effective as 150 μg/kg in reducing emesis when compared with droperidol. Mean time to discharge from the recovery room was 75.3 minutes (Group A), 44.4 minutes (Group B), and 41.0 minutes (Group C). The mean time to tolerating oral fluids was 356.5 minutes (Group A), 402.8 minutes (Group B), and 378.1 minutes (Group C). There was no statistical difference in discharge times from recovery or time to tolerating oral fluids in any of the three groups.

scholarly journals Banded Sleeve Gastrectomy Improves Weight Loss Compared to Nonbanded Sleeve: Midterm Results from a Prospective Randomized Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Paolo Gentileschi ◽  
Emanuela Bianciardi ◽  
Leandro Siragusa ◽  
Valeria Tognoni ◽  
Domenico Benavoli ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Weight Regain ◽  
Randomized Study ◽  
Banded Sleeve Gastrectomy ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
To Receive

Background. Weight regain after laparoscopic sleeve gastrectomy (LSG) is nowadays a growing concern. Sleeve dilatation and loss of food restriction is considered the main mechanism. The placement of a silicon ring around the gastric tube seems to give benefits in the short term. We report the results of a randomized study comparing LSG and laparoscopic banded sleeve gastrectomy (LBSG) over a 4-year follow-up. Objectives. To evaluate the efficacy of banded sleeve gastrectomy compared to standard sleeve in the midterm. Methods. Between 01/2014 and 01/2015, we randomly assigned 50 patients to receive one of the two procedures. Patients’ management was exactly the same, apart from the band placement. We analyzed differences in weight loss, operative time, complication rate, and mortality, with a median follow-up of 4 years. Results. Twenty five patients were assigned to receive LSG (Group A) and 25 LBSG (Group B). The mean preoperative BMI (body mass index) was 47.3 ± 6.58 kg/m2 and 45.95 ± 5.85 kg/m2, respectively. There was no significant difference in the operative time. No intraoperative or postoperative complications occurred. At 12-month follow-up, the mean BMI was 29.72 ± 4.40 kg/m2 in Group A and 27.42 ± 4.47 kg/m2 in Group B (p=0.186). After a median follow-up of 4 years, the mean BMI in Group B was significantly lower than Group A (24.10 ± 4.52 kg/m2 vs 28.80 ± 4.62 kg/m2; p=0.00199). Conclusions. LBSG is a safe procedure, with no impact on postoperative complications. The banded sleeve showed a significant greater weight loss in the midterm follow-up. Considering the issue of weight regain observed after LSG, the placement of a perigastric ring during the first procedure may be a strategy to improve the results. This trial is registered with NCT04228185.

scholarly journals Oral and vaginal route of misoprostol for induction of labour: a comparative study

2019 ◽  
Vol 8 (5) ◽  
pp. 1956
Author(s):  
Deepti D. Sharma ◽  
Kavita A. Chandnani
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Induction Of Labour ◽  
Vaginal Route ◽  
Oral Misoprostol ◽  
Group A ◽  
The Mean ◽  
Vaginal Misoprostol ◽  
Group B ◽  
To Receive

Background: Induction of labour can be defined as “Artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods, for purpose of vaginal delivery.” The key factor for a successful induction is the status of cervix, its form, consistency and dilatation which is determined by the Bishop score. In case of unfavourable cervix or in the pregnancies remote from the term; prostaglandins are more effective than any other method of induction. Introduction of misoprostol, PGE1 analogue, for the induction of labour in 1993 and its approval for clinical use by ACOG (American College of Obstetrics and Gynecology) in 1999 has been the most significant advancement. It is the latest drug for induction of labour which is cheap and stable at room temperature and is being used worldwide in different doses and by various routes. We compared the most commonly preferred two routes; vaginal and oral in terms of success of induction and noted the adverse events and side effects in both routes.Methods: This was a prospective comparative study carried out at SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, Vadodara, Gujarat, 200 patients who required induction of labour were recruited after applying inclusion and exclusion criteria and were randomly divided in two groups- Group A meant to receive 50µg oral misoprostol, Group B - meant to receive 25µg vaginal misoprostol repeated 4 hourly up to maximum of five doses. Progress of labour was charted on the partograph. The mean induction delivery interval, mode of delivery, maternal and neonatal outcomes and complications were observed.Results: The mean induction to delivery interval was significantly less in vaginal group than oral (23.3±12.4 hours in oral vs. 17.3±10 hours in vaginal). Vaginal delivery and cesarean section rates were comparable in both groups (76% in Group A vs. 72% in Group B for vaginal delivery, 18% vs. 20% for Cesarean section, respectively). 58% patients in Group A required more than two doses as compared to 39% in group B, though the difference was statistically not significant. Significant number of patients required added oxytocin administration in Group A (72%). No major complications or adverse events were observed. Neonatal hyperbilirubinemia was seen more in Group A.Conclusions: Both Oral misoprostol in a dose of 50μg and vaginal misoprostol 25 μg every four hours, to a maximum of five doses, have the potential to induce labour safely and effectively. The vaginal route however is beneficial in effecting delivery in lesser time with few numbers of doses as compared to oral route.

scholarly journals Clinical efficacy of nutraceutical diet for cats with clinical signs of cutaneus adverse food reaction (CAFR)

2017 ◽  
Vol 20 (2) ◽  
pp. 269-276 ◽  
Author(s):  
F. Mazzeranghi ◽  
C. Zanotti ◽  
A. Di Cerbo ◽  
J.P. Verstegen ◽  
R. Cocco ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Clinical Signs ◽  
Skin Lesions ◽  
Food Allergies ◽  
Toxic Compounds ◽  
Adverse Food Reaction ◽  
Group A ◽  
The Mean ◽  
To Receive ◽  
Lesion Severity

Abstract Food allergies and food intolerances are clinically difficult to discriminate. Most often, along with cutaneous adverse food reactions or CAFR, they are classified as adverse food reactions, whose causes are numerous, including toxic compounds. Eighteen indoor-housed domestic cats with evident clinical symptoms related to CAFR (drooling, back and neck intense itching, neck eczema, chronic conjunctivitis and stomatitis) involving skin lesions were studied. Cytological evaluations of ear, skin and gingival swabs revealed an increased turnover of keratinocytes while the oxytetracycline ELISA determination showed an unexpected high amount of oxytetracycline in all cats at the first visit. All cats were then randomly assigned to receive a standard (SD group) or a nutraceutical diet (ND group) for 60 days. In the ND group a significant reduction of the mean serum concentration of oxytetracycline, pruritus intensity and skin lesion severity (**p<0.01, ***p<0.001, and ***p<0.001, respectively) was observed after 60 days, and associated with a significant improvement in the clinical picture. Although a direct correlation between oxytetracycline presence within cat sera and CAFR-related symptoms has never been described, this study highlights the benefit of a specific nutraceutical diet supplementation in improving clinical symptoms and skin lesions in cats with CARF.

scholarly journals Evaluation of Bleeding Rate and Time in Therapeutic Range in Patients Using Warfarin Before and During the COVID-19 Pandemic—Warfarin Treatment in COVID-19

2021 ◽  
Vol 27 ◽  
pp. 107602962110214
Author(s):  
Zeynep Yapan Emren ◽  
Oktay Şenöz ◽  
Ahmet Erseçgin ◽  
Sadık Volkan Emren
Keyword(s):  
Therapeutic Range ◽  
Treatment Process ◽  
International Normalized Ratio ◽  
Bleeding Complications ◽  
Demographic Parameters ◽  
Bleeding Rate ◽  
Time In Therapeutic Range ◽  
Warfarin Treatment ◽  
The Mean

The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal’s method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.

Impact of provision of time in therapeutic range value on anticoagulation management in atrial fibrillation patients on warfarin

2018 ◽  
Vol 94 (1110) ◽  
pp. 207-211 ◽  
Author(s):  
Duo Huang ◽  
Chi-Lap Wong ◽  
Kwan-Wa Cheng ◽  
Pak-Hei Chan ◽  
Wen-Sheng Yue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Clinic Visit ◽  
Controlled Study ◽  
Anticoagulation Management ◽  
Time In Therapeutic Range ◽  
Randomised Controlled Study ◽  
The Mean ◽  
Randomised Controlled ◽  
The Impact

IntroductionThe importance of time in therapeutic range (TTR) in patients prescribed warfarin therapy for stroke prevention in atrial fibrillation (AF) cannot be overemphasised.AimTo evaluate the impact of provision of TTR results during clinic visits on anticoagulation management.DesignSingle-centred, randomised controlled study.SettingFifteen arrhythmia clinics in Hong Kong.PatientsAF patients prescribed warfarin.InterventionsProvision of TTR or no provision of TTR.Main outcome measuresA documented discussion between doctors and patients about switching warfarin to a non-vitamin K oral anticoagulant (NOAC).ResultsFour hundred and eighty one patients with AF prescribed warfarin were randomly assigned to (1) a TTR provision group or (2) control. Their mean age was 73.6±12.0 years and 60.7% were men. The mean CHA2DS2-VASc score was 3.2±1.6 and the mean HASBLED score was 1.7±1.2. The mean TTR was 63.9%±29.9%. At the index clinic visit, 71 of 481 patients (14.8%) had a documented discussion about switching warfarin to a NOAC. Patients with provision of TTR results were more likely to discuss switching warfarin to a NOAC than controls (19.1% vs 10.6%, P=0.03), especially those with a TTR <65% (35.2% vs 10.6%, P<0.001). A higher proportion of patients with provision of TTR results switched to a NOAC (5.9% vs 4.1%, P=0.49).ConclusionsThe provision of TTR among patients on warfarin was associated with a discussion about switching from warfarin to a NOAC in those with TTR <65%, but did not result in actual switching to a NOAC, suggesting additional barriers.

Abstract TP234: "Last Known Normal" Accuracy Among Initial Responders: An Update

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alyssa Bautista ◽  
Christian Saavedra-Chavez ◽  
Chia-Chun Chiang ◽  
Julian Duda ◽  
Dawn Meyer ◽  
...  
Keyword(s):  
Time Interval ◽  
Continuous Training ◽  
Significant Discrepancy ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Group A ◽  
The Mean ◽  
Baseline Characteristics ◽  
Group B ◽  
Current Guidelines

Background: Because acute treatment in stroke is time-based for inclusion, efficacy and safety, obtaining an accurate Last Known Normal (LKN) is of critical importance in stroke codes. We sought to assess with a larger sample if the assessment of 1st documented LKN times has improved since our prior 2013 data. Methods: Data was obtained from an IRB approved stroke registry in a single center from July 2013 to December 2018, for LKN time documented by a neurologist (“LKN2”). Chart review was done to document 1st reported LKN time as documented by EMS (or ED if no runsheets available) (“LKN1”). Inpatient stroke codes and hospital transfers were excluded. Differences in LKN1 and LKN2 were computed and stratified into Groups A (LKN1 is earlier in time than LKN2), B (LKN1 is the same as LKN2), and C (LKN1 is later in time than LKN2). Baseline characteristics, thrombolysis rates, stroke code time interval metrics, 90-day disability and death, discharge disposition, and symptomatic ICH rates, were compared between groups. Results: Of 990 stroke codes, 397 or 40.1% had agreeable LKN1 and LKN2 times (Group B) (increased from a historic 26.4%;p=<.001), while 593 or 59.9% had a discrepancy in LKN1 and LKN2 times. Of 593, 177 (29.8%) had an LKN1 earlier than LKN2 (Group A), 416 (70.2%) had LKN1 later than LKN2 (Group C). The mean age in Groups A, B, and C were 63.5, 63.4, and 66.1, respectively (p=0.04). Discharge disposition to home/self-care was seen more in Group C (n=284, 69.4%;A n=117, 63.2%;B n=255, 66.2%;p=0.03). There were no other differences in baseline characteristics, r-tPA rates, 90-day disability and death, or sICH rates. Among Group C patients who were excluded from IV-tPA based on time, 55.6% would have been treated outside of stroke guidelines had LKN1 been used (55.6% vs. prior report of 69.7%;p=0.2). Conclusion: Though initial LKN times obtained by EMS and ED responders have improved over time, there remains a significant discrepancy with 60% incorrect initial reports. Caution should be used when considering rt-PA treatments based on these LKN1 reports as 56% of cases could have been treated outside of current guidelines and evidence. This study highlights the need for continuous training in obtaining accurate LKN times and caution about using initial estimates of time.

scholarly journals Effect of Prayer on Intensity of Migraine Headache

2016 ◽  
Vol 22 (1) ◽  
pp. 37-40 ◽  
Author(s):  
Haleh Tajadini ◽  
Nasser Zangiabadi ◽  
Kouros Divsalar ◽  
Hossein Safizadeh ◽  
Zahra Esmaili ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Migraine Headache ◽  
Controlled Trial ◽  
Prospective Randomized Controlled Trial ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
To Receive ◽  
Pain Coping Strategy

Background and Aim. Migraine is a common form of headache that affects patients quality of life negatively. In addition to pharmacologic treatment, there are a variety of nonpharmacologic treatments for migraine headache. In present study, we examined the effect of prayer on intensity of migraine pain. Methods. In a prospective, randomized, controlled trial from October 2013 to June 2014, this study has been conducted in Kerman, Iran. We randomly assigned 92 patients in 2 groups to receive either 40 mg of propranolol twice a day for 2 month (group “A”) or 40 mg of propranolol twice a day for 2 months with prayer (group “B”). At the beginning of study and 3 months after intervention, patients’ pain was measured using the visual analogue scale. Results. At the beginning of study and before intervention, the mean score of pain in patients in groups A and B were 5.7 ± 1.6 and 6.5 ± 1.9, respectively. According to results of independent t test, mean score of pain intensity at the beginning of study were similar between patients in 2 groups ( P > .05). Three month after intervention, mean score of pain intensity decreased in patients in both groups. At this time, the mean scores of pain intensity were 5.4 ± 1.1 and 4.2 ± 2.3 in patients in groups A and B, respectively. This difference between groups was statistically significant ( P < .001). Conclusions. The present study revealed that prayer can be used as a nonpharmacologic pain coping strategy in addition to pharmacologic intervention for this group of patients.

scholarly journals A study of vaginal misoprostol tablet versus intra cervical dinoprostone gel for the induction of labour

2017 ◽  
Vol 6 (4) ◽  
pp. 1404
Author(s):  
Chandni N. Badlani ◽  
Shraddha S. Shastri ◽  
Neelesh S. Risbud
Keyword(s):  
Cost Effective ◽  
Induction Of Labor ◽  
Significant Difference ◽  
Misoprostol Group ◽  
Group A ◽  
The Mean ◽  
Nicu Admission ◽  
Vaginal Misoprostol ◽  
Group B ◽  
To Receive

Background: This was a comparative study conducted to compare the effectiveness of 25 microgram of intravaginal misoprostol with intracervical dinoprostone gel in terms of efficacy of drug, feto-maternal outcome, side effects and complications of drugs.Methods: 400 nulliparas at term, admitted for induction of labor were included in this study. They were randomly selected to receive either intravaginal misoprostol or intracervical dinoprostone gel. Group A (200 women) recieved tablet misoprostol 25 micrograms vaginally 4 hrly to a maximum of 3 doses and Group B (200 women) received dinoprostone gel 0.5mg intracervically 6 hrly to a maximum of 3 doses. Comparison was done in terms of Induction to delivery interval, need for augmentation, LSCS and instrumentation rate, need for NICU admissions and cost effectiveness.Results: The mean induction to delivery interval was less in the misoprostol group than dinoprostone group (12.5 hrs vs. 20 hrs). 78% patients delivered in the first 24 hrs in misoprostol group compared to 52 % patients in dinoprostone group. Group A had a higher success rate (81% vs.76%) and also required less augmentation of labor ( 30% vs. 60%) compared to group B. Need for LSCS was also lower in misoprostol group (11% vs. 16%). Need for instrumentation and incidence of NICU admission was similar in both groups. Misoprostol was more cost effective compared to dinoprostone.Conclusions: The misoprostol group had a shorter induction to delivery interval, more number of deliveries in the first 24 hrs of induction and a reduced need of augmentation of labor with oxytocin. There was no significant difference in the rate of caesarean section, hyper-stimulation syndrome, neonatal and maternal morbidity between the two groups. Thus, misoprosol appears to be safer, cheaper and more efficacious alternative for induction of labor especially for non-fetal indications as compared to dinoprostone gel.

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