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41. Canadian stroke best practice recommendations: secondary prevention of stroke, sixth edition practice guidelines

of recurrent stroke. Using data from secondary prevention trials, the 2009 Antithrombotic Trialists’ Collaborative (ATTC) meta-analysis, reported that the use of aspirin was associated with a 19%reductionintheriskoffutureischemicstrokeand a23%reductioninstrokeofunknowncause,withouta signi?cantly increased risk of hemorrhagic stroke. 42 The combination of clopidogrel plus aspirin has been associated with a 21% reduction in the risk of stroke and a 15% reduction in the risk of major vascular events, compared (...) with aspirin alone; however, the risks of major bleeding and intracranial hemorrhage Note: These recommendations are applicable to ischemic stroke and transient ischemic attack. 6.1 All patients with ischemic stroke or transient ischemic attack should be prescribed antiplatelet therapy for secondary pre- vention of recurrent stroke unless there is an indication for anticoagulation [Evidence Level A]. i. Acetylsalicylic acid (80–325 mg daily), combined acetylsalicylic acid (25 mg) and extended-release

2018 CPG Infobase

43. Cardiac arrhythmias in coronary heart disease

of omega-3 fatty acid for SCD prevention in patients with CVD, benefits were only observed in patients receiving suboptimal medical management. In patients treated according to guidelines, omega-3 fatty acids did not reduce the risk ratio of SCD (RR 0.96, 95% CI 0.84 to 1.10). 69 The impact of statins, aspirin, angiotensin converting enzyme (ACE) inhibitors and antiplatelet agents (reflecting current medical management) removed any benefit from the omega-3 fatty acid supplements. In a meta-analysis

2018 SIGN

44. Management of stable angina

the diagnosis of stable angina is suspected but not clear from history alone. R In patients with suspected stable angina, the exercise tolerance test should not be used routinely as a first-line diagnostic tool. 2.2 STABLE ANGINA AND NON-CARDIAC SURGERY R The routine use of aspirin to reduce perioperative cardiac events in patients undergoing non-cardiac surgery, including those with known stable coronary artery disease, is not recommended. Management of stable angina| 7 3 Diagnosis and assessment Angina (...) of patients with stable angina undergoing non-cardiac surgery and what is the optimum antiplatelet regimen in different patient groups? Management of stable angina| 49 y In patients with stable angina who are taking warfarin and are scheduled to undergo PCI with DES, should the warfarin be stopped, be combined with DAPT or be used as a an alternative to aspirin or clopidogrel? y What aspects of psychological therapy (for example cognitive, behavioural and relaxation components) are effective in relieving

2018 SIGN

45. Pharmacological management of migraine

for the purpose of implementation in NHSScotland. Pharmacological management of migraineContents 1 Introduction 1 1.1 The need for a guideline 1 1.2 Remit of the guideline 2 1.3 Statement of intent 3 2 Key recommendations 5 2.1 Acute treatment 5 2.2 Prevention of migraine 6 2.3 Medication-overuse headache 6 3 Treatment for patients with acute migraine 7 3.1 Introduction 7 3.2 Aspirin 7 3.3 Non-steroidal anti-inflammatory drugs 8 3.4 Paracetamol 8 3.5 Antiemetics 9 3.6 Triptans 9 3.7 Combined therapies 11 3.8 (...) with the frequent use of acute medication, for more than three months. 5 In the majority of patients this is a complication of migraine and patients with MOH often have a chronic migraine pattern (see section 5). Importantly, not all patients with chronic migraine frequently using acute treatment have MOH; some have poorly-treated migraine. For triptans, opioids and combination analgesics 10 or more days use per month is considered sufficient to cause MOH, and for simple analgesics (eg aspirin, ibuprofen

2018 SIGN

48. ESC/EACTS Guidelines on Myocardial Revascularization

for Effectiveness of Left Main Revascularization FAME Fractional Flow Reserve versus Angiography for Multivessel Evaluation FDG-PET Fluorodeoxyglucose positron emission tomography FFR Fractional flow reserve FITT-STEMI Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction FMC First medical contact FREEDOM Future Revascularization Evaluation in Patients with Diabetes Mellitus GLOBAL LEADERS Long-term ticagrelor monotherapy versus standard dual antiplatelet therapy followed by aspirin (...) underGoing elective stent placement on clopidogrel to Guide alternative thErapy with pRasugrel TRITON-TIMI 38 TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel–Thrombolysis In Myocardial Infarction TROPICAL-ACS Testing responsiveness to platelet inhibition on chronic antiplatelet treatment for acute coronary syndromes TVR Target vessel revascularization TWILIGHT Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention UFH

2018 European Society of Cardiology

49. Kaiser Permanente National Cholesterol and Cardiovascular Risk Clinician Guide

potential for ASCVD benefits and adverse effects before reinitiating niacin therapy. } To reduce the frequency and severity of adverse cutaneous symptoms: • Consider starting niacin at a low dose and titrate to a higher dose over a period of weeks as tolerated. • Consider taking niacin with food or premedicating with aspirin 325 mg 30 minutes before niacin dosing to alleviate flushing symptoms. • If an extended-release preparation is used, consider increasing the dose of extended-release niacin from 500

2018 Kaiser Permanente National Guideline Program

50. Depression

or use with caution if history of GI bleeding, patient over 80 years or taking non-steroidal anti-inflammatory drugs/ aspirin insomnia, sweating, impaired sexual function vivid dreams, agitation, hyponatraemia. Mirtazapine tablet and oro-dispersible tablet appetite stimulant and sedative, particularly at lower doses well tolerated in the elderly and patients with heart failure. Tricyclic antidepressants (under specialist advice) amitriptyline: also treats nerve pain. Side effects include: avoid

2018 Scottish Palliative Care Guidelines

51. Mouth Care

be rinsed thoroughly after meals. Dentures should be left out of the mouth overnight and soaked. Refer to ‘Edentulous patients’ advice. Mouth care if receiving chemotherapy/radiotherapy– key differences See local cancer centre/cancer network policy. Patients may be advised to avoid antipyretic analgesics (paracetamol, aspirin) if at risk of neutropenia (can mask fever due to sepsis). Patients receiving head and neck radiotherapy should avoid oil-based products. Other specialist advice regarding oral (...) by pain and inflammation of the mucous membrane which may present as painful mouth ulceration affecting any or all intra-oral surfaces. Analgesia: soluble paracetamol and/or aspirin used as a mouthwash provides no topical effect. Do not advise patients to use this as a mouthwash. If systemic analgesia required, see guideline. Chlorhexidine gluconate 0 . 2% mouthwash can be considered when pain limits other mouth care methods.10ml used twice daily may be useful to inhibit plaque formation in patients

2018 Scottish Palliative Care Guidelines

52. Migraine and Tension Headache

of tension headache Note: It is important to rule out medication overuse headache (MOH) prior to initiating therapy for any acute headache. See p. 12. Table 2. Pharmacologic options for acute treatment of tension headache ASPIRIN/NSAIDS (contraindicated if history of GI bleeds) Medication Initial dose Max dose Relative contraindications Special considerations Aspirin 500 mg x1, may repeat in 4-6 hours 4000 mg Age 10 days or > 15 days per month, depending on the medication.) Rule out medication overuse (...) published guidelines that meet the above standards, a literature search was conducted to identify studies relevant to the key questions that are not addressed by the external guidelines. Key questions addressed in the KPWA guideline 1. What is the clinical effectiveness of antiemetics, aspirin, NSAIDs, opioids, triptans, ergots, and corticosteroids for acute treatment of migraine with or without aura in patients aged > 13 years? 2. What is the clinical effectiveness of lisinopril, calcium channel

2018 Kaiser Permanente Clinical Guidelines

53. Cardiovascular Disease: Secondary Prevention

aspirin is recommended in most patients with ASCVD unless contraindicated due to hypersensitivity to aspirin, medication interactions, or the presence of severe peptic ulcer disease or gastritis. Note that patients who need to take an NSAID should continue taking it during antiplatelet therapy. Combination therapy is not recommended There is evidence that the harms of combined therapy (clopidogrel plus aspirin) generally outweigh the benefits except in patients with acute coronary syndrome (ACS (...) ) or PCI with stent. Table 4. Antiplatelet therapy for secondary prevention of ASCVD Line Medication Initial dose Maximum dose 1 st Aspirin 81 mg daily 81 mg daily 2 nd Clopidogrel 1 75 mg daily 75 mg daily 1 Clopidogrel is equally effective in patients with ASCVD who have a contraindication or intolerance to aspirin. 10 Lowering Triglycerides to Prevent Pancreatitis Triglycerides do not require investigation or treatment unless they are higher than 500 mg/dL. (Treatment/investigation at higher than

2018 Kaiser Permanente Clinical Guidelines

54. Cardiovascular Disease: Primary Prevention

the preferred cholesterol tests. Updated blood pressure targets: • 190 mg/dL, or diabetes. • Aspirin not recommended for patients with 190 mg/dL. • Statins not recommended for patients with 50%. • Cerebrovascular disease, such as transient ischemic attack, ischemic stroke, and carotid artery stenosis > 50%. • Peripheral artery disease, such as claudication. • Aortic atherosclerotic disease, such as abdominal aortic aneurysm and descending thoracic aneurysm. Primary prevention refers to the effort to prevent (...) of transaminase elevation when used for more than 16 weeks, especially among patients with CAD. • There is more recent evidence supporting the association of statins in general with the risk of diabetes mellitus. The association appears to be stronger with atorvastatin 80 mg and rosuvastatin compared to lower-intensity atorvastatin and other statins used. 20 Key question 7 Should we adopt the USPSTF recommendations on the use of aspirin for the primary prevention of ASCVD? • The U.S. Preventive Services Task

2018 Kaiser Permanente Clinical Guidelines

55. Iron Deficiency and Anaemia in Adults

), such as ibuprofen or aspirin. Menstrual pattern Particularly heavy or prolonged periods can lead to anaemia, but this may go unreported if a woman has always had periods of this kind and has not seen a marked difference in what she is used to. Establishing an idea of volume of loss and length of bleeding in days, as well as what is a normal pattern for the individual, is important. Pregnancy and lactation Both pregnancy and lactation place heavier demands on the body for the use of iron and iron stores

2018 Royal College of Nursing

56. Management of Pregnancy Subsequent to Stillbirth Full Text available with Trip Pro

: moderate). 6 Low-dose aspirin may reduce the risk of perinatal death in women at risk for placental insufficiency. Some women with a history of stillbirth may fall into this category (GRADE: high). 7 Women with a history of stillbirth may be at risk for fetal growth restriction in the subsequent pregnancy and may benefit from serial growth ultrasound (GRADE: high). While there is limited evidence supporting routine biophysical profile studies, some women and their families may benefit from increased

2018 Society of Obstetricians and Gynaecologists of Canada

57. Care of Women with Obesity in Pregnancy

pregnancy) may bene?t from taking 150 mg aspirin daily from 12 weeks of gestation until birth of the baby. B Women who develop hypertensive complications should be managed according to the NICE CG107. P What special considerations are recommended for prevention, screening, diagnosis and management of venous thromboembolism in women with obesity? Clinicians should be aware that women with a BMI 30 kg/m 2 or greater, prepregnancy or at booking, have a pre-existing risk factor for developing venous (...) : diagnosis and management. Clinical guidelines 107. Manchester: NICE; 2011. 89. Schumann NL, Brinsden H, Lobstein T. A review of national health policies and professional guidelines on maternal obesity and weight gain in pregnancy. Clin Obes 2014;4:197–208. 90. Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco MC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med 2017;377: 613–22. 91. Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N

2018 Royal College of Obstetricians and Gynaecologists

58. Antenatal and Postnatal Analgesia Full Text available with Trip Pro

, they may cause gastric irritation/ulcers. Diclofenac and ibuprofen are contraindicated in those with a known hypersensitivity and should be avoided in the following circumstances: If there has been significant haemorrhage, the women is hypovolaemic, and/or there is a risk of ongoing haemorrhage. In women with impaired renal function or with pre‐eclampsia. In women with severe asthma. In women with asthma known to be exacerbated by NSAIDs, including aspirin. In women with a history of gastric ulceration (...) . Aspirin‐induced asthma and cyclooxygenases . In: Vane, JR , Botting, J , editors. Selective COX‐2 Inhibitors: Pharmacology, Clinical Effects and Therapeutic Potential . Dordrecht : Springer Science+Business Media; 1998 . pp. 99 – 107 . 40 Dean, L . Codeine Therapy and CYP2D6 Genotype . In: V Pratt , H McLeod , L Dean , A Malheiro , W Rubinstein , editors. Medical Genetics Summaries [Internet] . Bethesda, MD : National Center for Biotechnology Information (US); 2012 [updated 2017]. 41 Madadi, P

2018 Royal College of Obstetricians and Gynaecologists

60. Peripartum Analgesia and Anesthesia for the Breastfeeding Mother

is widely used for anal- gesia. It may be given orally, rectally, and through the intravenous route; transfer into milk is low and appears to be less than the dosage given to infants 57 (III). • NSAIDs are commonly used for postpartum analgesia. While transfer of these medications into breast milk is low, this class of medications should be avoided in mothers of infants with ductal-dependent cardiac lesions 57 (IV). B Aspirin in a dose of 81 mg daily results in unde- tectable levels in human milk (...) . The transfer of drugs and therapeutics into human breast milk: An update on selected topics. Pediatrics 2013;132:796. 58. Datta P, Rewers-Felkins K, Kallem RR, et al. Transfer of low dose aspirin into human milk. J Hum Lact 2017;33: 296–299. 59. Weibert RT, Townsend RJ, Kaiser DG, et al. Lack of ibuprofen secretion into human milk. Clin Pharm 1982;1: 457–458. 60. Wischnik A, Manth SM, Lloyd J, et al. The excretion of ketorolac tromethamine into breast milk after multiple oral dosing. Eur J Clin Pharmacol

2019 Academy of Breastfeeding Medicine

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