Fluctuating International Normalized Ratio in Patients Compliant on Warfarin: Could Gastroparesis Be the Cause?

Warfarin is the drug of choice to achieve therapeutic anticoagulation in patients with mechanical heart valves. Factors that interfere with the reliable absorption of warfarin may result in difficult to control international normalized ratio (INR) and can cause significant bleeding complications due to supra-therapeutic INR and thromboembolism from sub-therapeutic INR. The patient's non-compliance is an important factor leading to difficult to control INR but there are additional factors that should be considered in difficult cases when dietary and medication compliance are observed.

Radial versus femoral access for emergent percutaneous coronary intervention with adjunct glycoprotein IIb/IIIa inhibition in acute myocardial infarction--the RADIAL-AMI pilot randomized trial.

Background: Transradial percutaneous coronary intervention (PCI) results in fewer vascular complications, earlier ambulation, and improved patient comfort. Limited data exist for radial access in acute myocardial infarction, where reperfusion must occur quickly.

Methods: In a multicenter pilot trial, 50 patients with myocardial infarction requiring either primary or rescue PCI were randomized to radial or femoral access.