Severity: Warning
Message: file_get_contents(https://...@pubfacts.com&api_key=b8daa3ad693db53b1410957c26c9a51b4908&a=1): Failed to open stream: HTTP request failed! HTTP/1.1 429 Too Many Requests
Filename: helpers/my_audit_helper.php
Line Number: 176
Backtrace:
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 176
Function: file_get_contents
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 250
Function: simplexml_load_file_from_url
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 1034
Function: getPubMedXML
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 3152
Function: GetPubMedArticleOutput_2016
File: /var/www/html/application/controllers/Detail.php
Line: 575
Function: pubMedSearch_Global
File: /var/www/html/application/controllers/Detail.php
Line: 489
Function: pubMedGetRelatedKeyword
File: /var/www/html/index.php
Line: 316
Function: require_once
Objective: To describe Mohs micrographic surgery and evaluate whether direct oral anticoagulants should be withheld in patients with atrial fibrillation (Afib) prior to the procedure and to consider what type of antibiotic prophylaxis should be used.
Setting: A community setting in which an elderly patient is living independently at home.
Practice Description: Academic-affiliated internal medicine clinic that cares for adult patients of all ages, including elderly patients living independently in their own home. The practice occasionally consults with geriatric specialty pharmacists to obtain drug information regarding drug therapy.
Practice Innovation: Identify and assess literature regarding therapeutic issues regarding patients with Afib, whether direct oral anticoagulants should be withheld prior to dermatologic surgery, and what type of antibiotic prophylaxis should be provided prior to the procedure.
Main Outcome Measurements: Highlight literature that assesses surgical bleeding risk if direct oral anticoagulants are continued, and alternatively, the risk of a thromboembolic event if discontinued; and address antibiotic prophylaxis prior to Mohs micrographic surgery in a patient with Afib.
Results: In an elderly patient with Afib, a pharmacist should evaluate bleeding risk if direct oral anticoagulants are continued, risk for stroke if anticoagulants are discontinued, and determine appropriate antibiotic prophylaxis prior to Mohs micrographic surgery.
Conclusion: In patients with Afib treated with direct oral anticoagulants who will have dermatologic surgery, the bleeding risk is usually low, whereas risk of a possible thromboembolic event is high, and antibiotic prophylaxis should be done to prevent infection.
Download full-text PDF |
Source |
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http://dx.doi.org/10.4140/TCP.n.2017.450 | DOI Listing |
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