Feasibility of a pharmacy-led intervention to de-implement non-guideline-concordant proton pump inhibitor use.

Background: Proton pump inhibitors (PPIs) are among the most prescribed medications and are often used unnecessarily. PPIs are used for the treatment of heartburn and acid-related disorders. Emerging evidence indicates that PPIs are associated with serious adverse events, such as increased risk of Clostridioides difficile infection.

Antithrombotic selection in patients undergoing transcatheter aortic valve replacement.

Purpose: Clinical controversy regarding the most appropriate antithrombotic regimen after transcatheter aortic valve replacement remains. Current evidence, guidelines, and recommendations are discussed.

Summary: Antithrombotic selection following transcatheter aortic valve replacement depends on a variety of patient-specific factors.

Pharmacist involvement in clinical assessment and laboratory testing for heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is a rare adverse drug reaction. The anti-PF4 antibody assay (ELISA) is utilized to assist in the clinical evaluation of HIT due to its high negative predictability and wide-spread availability. However, it also associated with false positive results.

Analysis of anticoagulant prescribing in non-valvular atrial fibrillation and development of a clinical tool for guiding anticoagulant selection.

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the United States. Traditionally, warfarin has been used to prevent the occurrence of stroke in intermediate-to-high risk patients. Target-specific oral anticoagulants (TSOACs) have become a favorable alternative; however, recommendations for differentiating between the available TSOACs were lacking within the 2012 CHEST guidelines.

Successful use of fondaparinux early after mechanical aortic valve replacement in a patient with a history of heparin-induced thrombocytopenia.

Thromboembolic complications such as systemic embolization and valve thrombosis are a major concern early after mechanical valve replacement; however, the benefit of anticoagulation must be weighed against the risk of early postoperative bleeding complications. Thromboembolic risk is also higher in the early postoperative period (less than 6 mo) compared with the risk in the late postoperative period. Current evidence supports the use of unfractionated heparin or low-molecular-weight heparin early after valve replacement to prevent valve thrombosis or systemic embolization but provides no recommendations for the management of patients with a history of heparin-induced thrombocytopenia (HIT), in which heparin products are contraindicated.