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Wehler CJ, Panchal NH, Cotchery DL, Farooqi OA, Ferguson DK, Foran D, Hakki OW, Silva R, Smith GM, Gibson G. Alternatives to opioids for acute pain management after dental procedures: A Department of Veterans Affairs consensus paper. J Am Dent Assoc 2021; 152:641-652. [PMID: 34325780 DOI: 10.1016/j.adaj.2021.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Opioid misuse is a widespread public health problem, and opioids are often prescribed in the dental environment. These recommendations provide alternatives to opioids to reduce or eliminate dental procedure-related acute pain. METHODS A multidisciplinary working group developed these clinical recommendations to specifically address procedure-related acute pain. These recommendations, which are based on published peer-reviewed research and guidelines, include therapies used before, during, and after dental procedures. When evidence is not definitive, the best practices, which are based on experts' consensus, are included. The recommendations are not intended to be exhaustive. RESULTS These recommendations are a summary of the evidence and best practices for opioid alternatives to treat acute pain related to dental procedures. CONCLUSIONS Dental providers should prioritize opioid stewardship when managing procedure-related pain with strategies such as thorough preprocedure pain assessment, minimally invasive techniques, preemptive analgesia, intraprocedure pain management, and appropriately selected postprocedure pharmacologic therapy. PRACTICAL IMPLICATIONS These recommendations are a concise resource for clinical providers. It is important to address patients' procedure-related pain, using nonopioids whenever possible. Alternatives are outlined, allowing providers to make informed decisions.
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Leong D, Wu PE. Warfarin and acetaminophen interaction in a 47-year-old woman. CMAJ 2021; 192:E506-E508. [PMID: 32575041 DOI: 10.1503/cmaj.191532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Derek Leong
- Department of Pharmacy (Leong) and Division of General Internal Medicine and Geriatrics (Wu), University Health Network; Division of Clinical Pharmacology and Toxicology (Wu), Department of Medicine, University of Toronto, Toronto, Ont.
| | - Peter E Wu
- Department of Pharmacy (Leong) and Division of General Internal Medicine and Geriatrics (Wu), University Health Network; Division of Clinical Pharmacology and Toxicology (Wu), Department of Medicine, University of Toronto, Toronto, Ont
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Does prophylactic antibiotic administration for tooth extraction affect PT-INR in patients taking warfarin? BMC Oral Health 2020; 20:331. [PMID: 33213431 PMCID: PMC7678308 DOI: 10.1186/s12903-020-01326-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Various antibiotics and analgesics have been reported to interact with warfarin. Reports that investigate the effects of medication taken for just a few days during tooth extraction on the prothrombin time-international normalized ratio are rare. Methods A total of 110 patients receiving long-term stable warfarin therapy underwent tooth extraction without interruption of warfarin treatment. INR values were measured 1 month before the tooth extraction, the day of the extraction, and 1 week after the extraction. We investigated the changes in INR values between the day of extraction and 1 week after extraction, as well as the various risk factors for increases in INR values. Results Before and after tooth extraction, the number of patients taking cefcapene pivoxil, amoxicillin, and azithromycin was 57, 36, and 8, respectively. Nine patients were administered ampicillin before tooth extraction and received amoxicillin after their tooth extraction. One week after tooth extraction, the INR values increased beyond the therapeutic range in 3 out of 110 patients (2.7%). The INR values before tooth extraction in these three patients were close to 3.0. The INR value increased by more than twice as much in 1 out of 110 patients (0.9%). Conclusion Our results suggest that prophylactic antibiotic administration has little effect on INR values when patients on stable warfarin therapy undergo tooth extraction. Surgeons have to take attention if the patients whose INR values are close to 3.0 before their extraction.
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Katerenchuk V, Duarte GS, Martins E Pereira G, Fernandes RM, Ferreira JJ, Pinto FJ, Costa J, Caldeira D. Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis. Thromb Haemost 2020; 121:366-382. [PMID: 33160289 DOI: 10.1055/s-0040-1716752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To undertake a systematic review and meta-analysis to assess the satisfaction of patients receiving nonvitamin K anticoagulants (NOACs), compared with vitamin K antagonists (VKAs). METHODS We searched CENTRAL, MEDLINE, Embase, and Clinicaltrials.gov for randomized controlled trials (RCTs) and observational studies. Two reviewers screened, extracted, and appraised data independently. We pooled data using a random-effects model. Outcome included treatment satisfaction, which was assessed by scores of Duke Anticoagulation Satisfaction Scale (DASS), Anticlot Treatment Scale (ACTS), Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), or Treatment Satisfaction Questionnaire for Medication version II (TSQM-VII) and their domains reported with 95% confidence intervals (95% CIs). We followed MOOSE and PRISMA guidelines. RESULTS We included four RCTs and 16 observational studies, enrolling 18,684 participants overall. Compared with VKAs, treatment with NOACs improved the ACTS Burdens score by 4.21 points (95% CI: 2.99-5.43, I 2 = 95%, combined n = 6,180), and ACTS Benefits by 0.49 points (95% CI: 0.18-0.81, I 2 = 85%, combined n = 6,171). Switching from VKAs to NOACs improved the ACTS Burdens score by 5.33 points (95% CI: 3.53-7.14, combined n = 3,097). Compared with VKAs, treatment with NOACs improved the TSQM-VII Global Satisfaction score by 6.86 points (95% CI: 3.00-10.73, combined n = 5,535). CONCLUSION In patients with nonvalvular atrial fibrillation or venous thromboembolism, NOAC treatment is associated with greater satisfaction compared with VKAs. The switch from VKAs to NOACs was associated with improved patients' satisfaction. These effects were largely due to a lower degree of treatment burden with NOAC treatment.
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Affiliation(s)
| | - Gonçalo S Duarte
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa (CAML), Lisboa, Portugal
| | | | - Ricardo M Fernandes
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Pediatria, Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte (CHLN), Centro Académico de Medicina de Lisboa, (CAML) Lisboa, Portugal
| | - Joaquim J Ferreira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Hospital de Santa Maria-CHLN, CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João Costa
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa (CAML), Lisboa, Portugal
| | - Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Cardiologia, Hospital de Santa Maria-CHLN, CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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5
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Girard P, Sourdet S, Cantet C, de Souto Barreto P, Rolland Y. Acetaminophen Safety: Risk of Mortality and Cardiovascular Events in Nursing Home Residents, a Prospective Study. J Am Geriatr Soc 2019; 67:1240-1247. [PMID: 30912588 DOI: 10.1111/jgs.15861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acetaminophen is the most widely used analgesic today. A recent systematic review found increased adverse events and mortality at therapeutic dosage. Our aim was to challenge these results in a large sample of older adults living in nursing homes (NHs). DESIGN Prospective study using data from the Impact of Educational and Professional Supportive Interventions on Nursing Home Quality Indicators project (IQUARE), a multicenter, individually tailored, nonrandomized controlled trial in NHs across southwestern France. SETTING/PARTICIPANTS We studied data from 5429 participants living in 175 NHs (average age, 86.1 ± 8.1 years; 73.9% women). MEASUREMENTS All prescriptions obtained at baseline were analyzed by a pharmacist for acetaminophen use as stand-alone or associated. Myocardial infarction (MI) and strokes were reported from participants' medical records at 18-month follow-up. Dates of death were obtained. Data collection was done through an online questionnaire at baseline and at 18 months by NH staff. Analyses were realized in our total population and a population matched on propensity score of acetaminophen intake. Six models were run for each outcome. RESULTS A total of 2239 participants were taking, on average, 2352 ± 993 mg of acetaminophen daily. Results for mortality were: hazard ratio (HR) = 0.97 (95% confidence interval [CI] = 0.86-1.10). No associations between acetaminophen intake and the risk of mortality or MI were found. In one of our models, acetaminophen intake was associated with a significant increased risk of stroke in diabetic subjects (OR = 3.19; 95% CI = 1.25-8.18; P = .0157). [Correction added March 16, 2019, after first publication online. In the previous sentence, "HR" was mistakenly used instead of "OR".] CONCLUSION: Despite old age, polypharmacy, and polymorbidity, acetaminophen was found safe for most, but not all, of our NH study population. Pain management in NHs is a health priority, and acetaminophen remains a good therapeutic choice as a first-line analgesic. More studies are needed on older diabetic patients.
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Affiliation(s)
- Philippe Girard
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Sandrine Sourdet
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Inserm unité mixte de recherche 1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Christelle Cantet
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Inserm unité mixte de recherche 1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Philipe de Souto Barreto
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Inserm unité mixte de recherche 1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Inserm unité mixte de recherche 1027, Université de Toulouse III Paul Sabatier, Toulouse, France
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Elalamy I, Hanon O, Deray G, Launay-Vacher V. Anticoagulants in frail patients. Seven situations at risk. JOURNAL DE MEDECINE VASCULAIRE 2018; 43:302-309. [PMID: 30217344 DOI: 10.1016/j.jdmv.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/30/2018] [Indexed: 06/08/2023]
Abstract
In the case of venous thromboembolic disease (VTE), physicians are facing more and more difficulties in managing VTE and their treatment in frail patients. These patients could present several risk situations such as: chronic kidney disease (CKD), underweight or malnourished, falls, cognitive impairment, multi-medicated patients, cancer and pregnancy. Guidelines typically recommend anticoagulation. There are multiple challenges in the safe use of anticoagulation in frail patients, including bleeding risk, monitoring and adherence, and polypharmacy. The objective of this review is to explore these at-risk situations and to suggest adequate anticoagulation therapy, when possible, in each of these complex situations.
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Affiliation(s)
- I Elalamy
- Hematology department, Tenon Hospital, 75020 Paris, France
| | - O Hanon
- Geriatrics department, Broca Hospital, 75013 Paris, France
| | - G Deray
- Service ICAR, Pitié-Salpêtrière Hospital, 75013 Paris, France; Nephrology department, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - V Launay-Vacher
- Service ICAR, Pitié-Salpêtrière Hospital, 75013 Paris, France; Nephrology department, Pitié-Salpêtrière Hospital, 75013 Paris, France.
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Leblanc A, Petitpain N, Pereira O, Adssi HE, Latarche C, Gillet P, Colnat-Coulbois S. [Intracranial hemorrhage and oral anticoagulants of patients treated between 2011 and 2013 at the Nancy Regional University Hospital]. Neurochirurgie 2017; 63:302-307. [PMID: 28882608 DOI: 10.1016/j.neuchi.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/03/2017] [Accepted: 02/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To perform a descriptive analysis of intracranial hemorrhages of patients treated with an antivitamin K (fluindione, acenocoumarol or warfarin) or a direct oral anticoagulant (dabigatran, rivaroxaban or apixaban) at the Nancy Regional University Hospital. MATERIAL AND METHOD The study period was from January 2011 to December 2013 and the computerized data (Programme de Médicalisation des Systèmes d'Information) of our hospital was accessed to identify the patients. Clinical data were obtained from the patients' files. Regional healthcare system was queried for reimbursement data. RESULTS Among the 157 identified cases of intracranial hemorrhage, 153 were related to antivitamin K, primarily fluindione (n=127), and only 4 to a direct oral anticoagulant (3 dabigatran and 1 rivaroxaban). During the same period, regional data indicated that 65,345 patients had had at least one reimbursement of antivitamin K and 20,983 patients one reimbursement of an oral direct anticoagulant. In our series, the most frequent intracranial hemorrhages were subdural hematoma (chronic in 65 cases, acute in 50 cases) and intraparenchymal hemorrhage (20 cases). The global mortality rate was 20.2% but varied with the site of hemorrhage. In multivariate analysis, the two risk factors of fatal outcome were coma on admission (OR 6.2; 95%CI: 2.6-15.0) and a history of previous intracranial hemorrhage (OR 13,4; 95% CI: 1,6-114,9). CONCLUSION During the 2011-2013 period, antivitamin K, especially fluindione, was the most frequently involved anticoagulants in intracranial hemorrhages with hospitalization at our Regional University Hospital. Coma on admission and a history of previous intracranial hemorrhage were the two main risk factors for fatal outcome.
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Affiliation(s)
- A Leblanc
- Centre régional de pharmacovigilance de Lorraine, hôpital Central, CHRU de Nancy, 29, avenue de Lattre-de-Tassigny, 54035 Nancy, France
| | - N Petitpain
- Centre régional de pharmacovigilance de Lorraine, hôpital Central, CHRU de Nancy, 29, avenue de Lattre-de-Tassigny, 54035 Nancy, France.
| | - O Pereira
- Direction régionale du service médical du Nord-Est, 54000 Nancy, France
| | - H El Adssi
- Département d'information médicale, hôpital St-Julien, CHRU de Nancy, 54000 Nancy, France
| | - C Latarche
- Coordination qualité risques et vigilances, CHRU de Nancy, 54000 Nancy, France
| | - P Gillet
- Centre régional de pharmacovigilance de Lorraine, hôpital Central, CHRU de Nancy, 29, avenue de Lattre-de-Tassigny, 54035 Nancy, France
| | - S Colnat-Coulbois
- Service de neurochirurgie, hôpital Central, CHRU de Nancy, 54000 Nancy, France
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Merel SE, Paauw DS. Common Drug Side Effects and Drug-Drug Interactions in Elderly Adults in Primary Care. J Am Geriatr Soc 2017; 65:1578-1585. [PMID: 28326532 DOI: 10.1111/jgs.14870] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 12/18/2022]
Abstract
Prescribing medications, recognizing and managing medication side effects and drug interactions, and avoiding polypharmacy are all essential skills in the care of older adults in primary care. Important side effects of medications commonly prescribed in older adults (statins, proton pump inhibitors, trimethoprim-sulfamethoxazole and fluoroquinolone antibiotics, zolpidem, nonsteroidal antiinflammatory drugs, selective serotonin reuptake inhibitors, dipeptidyl peptidase 4 inhibitors) were reviewed. Important drug interactions with four agents or classes (statins, warfarin, factor Xa inhibitors, and calcium channel blockers) are discussed.
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Affiliation(s)
- Susan E Merel
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Douglas S Paauw
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
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