Meta-analysis of currently available studies showed no significant difference in bleeding and thromboembolism between interrupted dabigatran and warfarin therapy in CA of AF. Dabigatran appears to be safe and effective for peri-procedural anticoagulation in CA of AF.

Background Left ventricular thrombus is a frequent complication of acute myocardial infarction and a risk factor for thromboembolic complications. Warfarin has been frequently used, but has some disadvantages that limit its use. Direct oral anticoagulants, in particular Dabigatran and Rivaroxaban have been proved to be effective in preventing thromboembolism among patients with non-valvular atrial fibrillation. However, no randomized clinical trials testing the efficacy and safety of these agents in patients with existing left ventricular thrombus. Furthermore, direct oral anticoagulants are still not approved by the Food and Drug Administration in the management of left ventricular thrombus. Method This study was a retrospective cohort assessing the efficacy of direct oral anticoagulants (Dabigatran or Rivaroxaban) on the resolution of left ventricular thrombus in patients taking either of these drugs during the study period from December, 2011 to December, 2016 at King Fahad Medical City. All patients’ records were reviewed and all patients who were diagnosed with left ventricular thrombus were included. Patients without available echocardiogram records were excluded. The study was approved by the institutional review board of King Fahad medical city, Riyadh Saudi Arabia. Result During the defined study period we found that 413 and 1218 patients were taking Dabigatran and Rivaroxaban, respectively. After filtering them based on the specialty of the prescriber, we ended up with 299 patients who have been started on Dabigatran and 448 patients who have been started on Rivaroxaban by cardiologists. Moreover, after reviewing echocardiogram reports for all of them (747 patients), we found that 11 patients were diagnosed to have left ventricular thrombus. Among those 11 patients, seven of them were treated with direct oral anticoagulants from the beginning and the remaining four patients were shifted from Warfarin to direct oral anticoagulants. All of them (7 patients) showed left ventricular thrombus resolution on follow-up echocardiogram. Conclusion Use of direct oral anticoagulants showed promising results in the resolution of left ventricular thrombus in patients diagnosed with left ventricular thrombus. Further studies at multiple health care centers are needed to further evaluate the efficacy and safety of direct oral anticoagulants as compared to traditional treatment in patients with left ventricular thrombus.

BackgroundEstablishing evidence-based medicine (EBM) is important for pharmaceutical care services to be effective and for adding value to patient care. Increasing examples are illustrating that health professionals hold positive attitudes toward EBM. Nevertheless, their knowledge and skills are relatively insufficient. The objective of this study was to assess the impact of research educational intervention on knowledge, attitudes, perceptions, and pharmacy practices towards evidence-based medicine among junior pharmacists.MethodsA one group pre-test/post-test quasi-experimental design was conducted on postgraduate junior pharmacy staff working or training at one of the three randomly selected tertiary care settings in Riyadh, Saudi Arabia. This study consisted of two phases. During the first phase, a structured questionnaire assessing the knowledge, perceptions, and attitudes of the participants regarding EBM, as well as basic biostatistics, epidemiology and the utilization of EBM, was administered. The second phase was scheduled to begin four weeks after the distribution of the educational materials, whereby the same questionnaire was redistributed among the same participants.ResultsSixty-seven pharmacists participated in this study. The overall percentage mean score of correct responses of the study participants' knowledge was 37.0% in the pre-test compared to 44.4% in the post-test. The percentage mean score of correct responses for biostatistics and epidemiology and study design sections significantly increased after the study intervention (p < 0.001), (p = 0.02), respectively. Regarding the study participants' attitudes towards EBM, only one item, "Willingness to support the promotion of EBM implementation,” was statistically significantly higher in the post-test (61, 93.8%) participants compared to participants (53, 80.3%) in the pre-test, while "Possessing sufficient skills to implement EBM principles" was the only statistically significant item for the study participants' perceptions towards EBM in the pre-test compared to the post-test, (82.1%, 92.4%), respectively. Moreover, our results showed that 74.6% of the respondents were practicing EBM before the study intervention versus 81.5% after the intervention.ConclusionThe results of this study reveal that comprehensive educational intervention might improve the knowledge, attitudes, and perceptions of EBM among pharmacists and encourage them to incorporate this into their everyday clinical practice.

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Background: The SAMe-TT2 R2 Score was developed to identify vitamin K antagonists control outliers before non-valvular atrial fibrillation (AF) patients start treatment. SAMe-TT2 R2 Score was derived and validated using a primarily white Caucasian population to predict TTR. Given that non-Caucasian race already confers 2 points in this score, the SAMe-TT2 R2 score requires validation and/or re-calibration despite race of population. Method: We conducted a cohort retrospective study that included all non-valvular atrial fibrillation patients who were on warfarin therapy from January to December 2019. Then we calculated the modified SAMe-TT2 R2 and SAMe-TT2 R2 for all study populations and we correlated the result with patients' TTR. The TTR was calculated through the Rosendaal's method. Results: We had 662 patient using warfarin therapy, among those 662, 60.9% were under cardiology and using it for cardiac indication, and only 18.1% diagnosed to have non-valvular AF. Modified SAMe-TT2 R2 score has good relation to original SAMe-TT2 R2 score as showed 75.71% (95% CI. 63.99 to 85.17%), 100% (95% CI. 92.89 to 100%) and 15% (95% CI. 3.21 to 77.95%); accuracy, sensitivity and specificity in relation to SAMe-TT2 R2 respectively. In addition to that in this small cohort we found that there is universal relationship between SAMe-TT2 R2 score, Modified SAMe-TT2 R2 score and TTR; TTR >=65% associate with low score (<2) of both SAMe-TT2 R2 , Modified SAMe-TT2 R2 score. Conclusion: The use of Modified SAMe-TT2 R2 score allows clinicians to make an informed decision on whether to start vitamin K antagonist or other non-vitamin K antagonist oral anticoagulant despite the race of the patients.