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162. Guidelines on the Management of Patients with Vestibular Schwannoma

: Lapatinib may be considered for use in reducing VS size and improvement in hearing in NF2. Level 3: Erlotinib is not recommended for use in reducing VS size or improvement in hearing in patients with NF2. Level 3: Everolimus is not recommended for use in reducing VS size or improvement in hearing in NF2. RECOMMENDATION: Level 3: It is recommended that aspirin administration may be considered for use in patients undergoing observation of their VS. RECOMMENDATION: Level 3: Perioperative treatment

2018 Congress of Neurological Surgeons

165. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

stent placement or, alternatively, performing EVAR with continuation of dual antiplatelet therapy. Level of recommendation 2 (Weak) Quality of evidence B (Moderate) In patients with a drug-eluting coronary stent requiring open aneurysm repair, we recommend discontinuation of P2Y 12 platelet receptor inhibitor therapy 10 days preoperatively with continuation of aspirin. The P2Y 12 inhibitor should be restarted as soon as possible after surgery. The relative risks and benefits of perioperative

2018 Society for Vascular Surgery

167. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

on NCCT of mild to moderate extent (other than frank hypodensity). ( Class I; LOE A ) Prior antiplatelet therapy IV alteplase is recommended for patients taking antiplatelet drug monotherapy before stroke on the basis of evidence that the benefit of alteplase outweighs a possible small increased risk of sICH. ( Class I; LOE A ) IV alteplase is recommended for patients taking antiplatelet drug combination therapy (eg, aspirin and clopidogrel) before stroke on the basis of evidence that the benefit

2018 American Heart Association

168. British Association of Dermatologists? guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis

normal- ization of blood counts with venesection or cytoreductive therapy. 36 Aspirin 300 mg daily has been shown to be effec- tive in relieving pruritus in a number of patients with PV. 54,55 There is evidence from case reports that pruritus associated with PV may be helped by sodium bicarbonate baths. 56 How- ever, this has not been con?rmed in all cases. Interferon alpha therapy may also be useful. 57 It has the added advantage of being a cytoreductive therapy and there- fore a treatment for PV (...) with cimetidine, gabapentin, carbamazepine, mirtazapine or phototherapy (Strength of recommendation D; Level of evidence 3) ? Patients with generalized pruritus associated with incurable lymphoma may have their itch relieved with oral corticosteroids (Strength of recommendation D; Level of evidence 4) ? Patients with generalized pruritus associated with PV may have their itch relieved with cytoreductive ther- apy, aspirin, interferon-a, SSRIs, PUVA, UVB pho- totherapy, cimetidine or atenolol (Strength

2018 British Association of Dermatologists

171. Pulmonary Embolism Diagnosis and Treatment

Adjust dose per warfarin dosing calculator or per AMS. Dabigatran CBC Annually. Thrombocytopenia — Serum creatinine Annually. Check every 3 months if CrCl is between 30–49 mL/min. — Stop dabigatran if CrCl 80% reduction observed with the VKAs or DOACs. • There is insufficient evidence to determine whether aspirin should be used for extended treatment of patients with unprovoked VTE who are at low risk of recurrence. • There is insufficient evidence to determine the optimal duration of aspirin therapy (...) for patients at moderate risk of recurrence. • A number of meta-analyses and one RCT investigated the extended treatment of VTE with DOACs, warfarin, and aspirin (Marik 2015, Sobieraj 2015, Weitz 2017). The overall results showed a significant reduction in the risk of recurrent VTE, but the risk of bleeding associated with the individual treatments differed across meta- analyses, which could be explained by the different inclusion/exclusion criteria of the meta-analyses. 17 • The results of the published

2017 Kaiser Permanente Clinical Guidelines

174. Imaging Guidelines

warfarin or aspirin developed delayed intracerebral bleeding, none of which required intervention. 3,8,9 Studies examining individual oral anticoagulant or antiplatelet agents yield similar results. Patients taking warfarin who had supra- therapeutic INR levels (greater than 3) had an increased risk of developing a new bleed following an initial negative head CT. A recent meta-analysis of 1,594 patients on pre-injury warfarin with a normal initial head CT estimated a 0.6 percent pooled incidence (...) head CT scan, unlike patients who are not on anticoagulation. In patients on platelet inhibitors alone (aspirin, clopidogrel) more contradictory data have been reported. Many studies and algorithms considered aspirin to be a low-risk medication; however, recent data question that assertion. 11 In a prospective observational study of 265 patients with ICH on initial head CT, both aspirin and clopidogrel were identified as independent predictors of mortality and the need for neurosurgical

2018 American College of Surgeons

175. Early Pregnancy Loss

? No workup generally is recommended until after the second consecutive clinical early pregnancy loss (7). Maternal or fetal chromosomal analyses or testing for inherited thrombophilias are not recommended rou- tinely after one early pregnancy loss. Although throm- bophilias commonly are thought of as causes of early pregnancy loss, only antiphospholipid syndrome con- sistently has been shown to be significantly associated with early pregnancy loss (56, 57). In addition, the use of anticoagulants, aspirin (...) treatment using 800 micrograms of vaginal misoprostol is recommen- ded, with a repeat dose as needed. The addition of a dose of mifepristone (200 mg orally) 24 hours before misoprostol administration may significantly improve treatment efficacy and should be considered when mifepristone is available. < The use of anticoagulants, aspirin, or both, has not beenshowntoreducetheriskofearlypregnancyloss inwomenwith thrombophilias except inwomenwith antiphospholipid syndrome. The following recommendations

2018 American College of Obstetricians and Gynecologists

176. Mechanical and Bioprosthetic Heart Valves: Anticoagulant Therapy

heparin (LMWH) until a therapeutic INR has been attained. Maintenance of a therapeutic INR is important to reduce the risk of thrombosis. [See Warfarin Guide and Warfarin: Management of Out-of-Range INR Guide]. Aspirin It is recommended that patients with a mechanical aortic or mitral valve who are at low risk of bleeding should receive ASA (81 mg daily) in addition to the warfarin therapy. Caution should be used in patients with an increased bleeding risk, especially with a history

2017 Thrombosis Interest Group of Canada

177. Atrial Fibrillation Full Text available with Trip Pro

or recurrent cardiac ischaemia or infarction, and stent thrombosis) should be undertaken for patients with AF who have a long-term requirement for anticoagulation for stroke prevention and require dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) or stent implantation (or both). Low Strong Duration of triple therapy (aspirin, P2Y 12 inhibitor and OAC) should be as short as possible to minimise bleeding, while ensuring coverage of the initial period of high risk of stent thrombosis (...) and/or recurrent coronary ischaemia. Moderate Strong Where DAPT is required in combination with OAC, low-dose aspirin (100 mg) and clopidogrel (75 mg) are recommended. Ticagrelor and prasugrel are not recommended in this situation. Low Strong Where OAC is used for AF, discontinuation of antiplatelet therapy should be considered 12 months after stent implantation, ACS, or both, with continuation of OAC alone. Low Weak Anticoagulation in special situations—chronic kidney disease (CKD) The decision to use

2018 Cardiac Society of Australia and New Zealand

179. SMFM Statement Pharmacological treatment of gestational diabetes Full Text available with Trip Pro

diabetes. Cochrane Database Syst Rev . 2017 ; 11 : CD012037 | Metformin is an oral biguanide that primarily acts to decrease hepatic glucose production by inhibiting gluconeogenesis. It also increases glucose uptake in peripheral tissues and decreases glucose absorption in the gastrointestinal tract. x 14 Romero, R., Erez, O., Hüttemann, M. et al. Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity (...) . et al. Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity. Am J Obstet Gynecol . 2017 ; 217 : 282–302 | | | | | | 15 Gui, J., Liu, Q., and Feng, L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PloS One . 2013 ; 8 : e64585 | | | | 16 Charles, B., Norris, R., Xiao, X., and Hague, W. Population pharmacokinetics of metformin in late pregnancy. Ther Drug Monit

2018 Society for Maternal-Fetal Medicine


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