64 Finally, the median cost of managing a patient after amputation is estimated at almost twice that of successful limb salvage.65 Thus, critical limb ischemia represents a challenging disease state that is associated with considerable morbidity and mortality and a
large financial impact on society. CONCLUSION Chronic critical limb ischemia is a significant, often under-recognized facet of atherosclerotic disease that has significant medical and functional consequences. A thorough understanding of the systemic risk factors associated with the disease followed by rapid intervention Inhibitors,research,lifescience,medical and interruption of the process is necessary to improve outcomes and prevent limb loss and death. Conflict of Interest Disclosure: The author has completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported. Funding/Support:
Inhibitors,research,lifescience,medical The author has no funding disclosures.
Introduction Anticoagulation for atrial fibrillation has been dependant on warfarin for the past 30 years. However, the www.selleckchem.com/products/DAPT-GSI-IX.html recent FDA approvals of dabigatran and rivaroxaban and the expected approval for apixaban have provided several new alternatives for our patients. Many factors must be considered when selecting the most appropriate agent for preventing stroke in nonvalvular atrial fibrillation. Inhibitors,research,lifescience,medical The following trials have provided the foundation for decision making when considering alternatives to warfarin therapy. Pivotal Trials
Dabigatran The RE-LY trial compared two doses of dabigatran (110 mg twice daily and 150 mg twice daily) against dose-adjusted warfarin.1 The 150-mg dose Inhibitors,research,lifescience,medical of dabigatran proved superior to warfarin for stroke and systemic embolization (1.11% per year vs. 1.71% per year, P <0.001), whereas the 110-mg dose was noninferior (1.54% per year vs. 1.71% per year, P <0.001).2 Major bleeding was similar with the Inhibitors,research,lifescience,medical 150-mg dose of dabigatran compared to warfarin (3.32% per year vs. 3.57% per year, P=0.32); however, the 110-mg dose of dabigatran had significantly less bleeding complications (2.87% per year vs. 3.57% per year, P=0.003).2 Despite these outcomes, L-NAME HCl the FDA approved the 150-mg dose of dabigatran and the comparable 75-mg dose of dabigatran from pharmacokinetic models for patients with impaired renal function (creatinine clearance, or CrCl, between 15–30 mL/min).3 Rivaroxaban The ROCKET-AF trial compared rivaroxaban 20 mg daily (or 15 mg daily for renal impairment) to dose-adjusted warfarin. Rivaroxaban was noninferior to warfarin for stroke and systemic emboli (1.7% per year vs. 2.2% per year, P <0.001).4 The safety endpoint of major and nonmajor clinically relevant bleeding was similar between the two groups (14.9% per year vs. 14.5% per year, P=0.44).