A level-headed approach to measuring direct oral anticoagulants: A 2-year retrospective analysis of DOAC levels from a tertiary UK centre.

INTRODUCTION: Direct oral anticoagulants (DOAC) are commonly prescribed and measuring drug levels may be useful in a number of contexts. However, data on DOAC level measurement and their clinical utility in real-world studies are limited. METHODS: We carried out a 2-year retrospective cohort study of DOAC levels measured at our institution. RESULTS: One hundred and sixty-nine levels measured in 113 patients were included in the final analysis. Our patients had a median age of 69.9. AF was the commonest indication for anticoagulation. Median turnaround time for inpatient levels was 92 minutes. Median FXa inhibitor levels within 6 hours of last dose and following one half-life were similar to those described previously. However, the range of levels was wider than expected. Importantly, some levels remained in an on therapy range even after 3 half-lives. There was no correlation between dabigatran level and time from last dose. The reason for request varied with setting; 23 outpatient levels were to monitor drug efficacy, whereas 54 and 43 inpatient levels were collected in the context of bleeding and emergency surgery respectively. 60.3% of levels had an impact on clinical decision making. CONCLUSION: Our real-world study demonstrates that DOAC levels can be performed in a timely manner to influence clinical decision making. In addition, it suggests there is a wide variation in levels such that it can be difficult to predict in the real world. Overall, this supports the wider use of DOAC levels to help guide clinicians in managing patients taking these drugs.

Bronchodilator activity of the selective muscarinic antagonist revatropate in horses with heaves.

Bronchodilators are frequently used to attenuate airway obstruction in equine heaves (or recurrent airway obstruction). This study evaluated the selective (M(3) and M(1)) muscarinic antagonist revatropate, which offers potential advantages over non-specific antimuscarinic agents such as ipratropium. Protocol 1 assessed the response to inhaled revatropate (1, 2 and 7 mg) using a blinded, negative (inhaled saline) and positive (inhaled ipratropium bromide; 0.3, 0.7 and 2mg) controlled, dose escalation study, with six heaves horses. The lowest doses of revatropate and ipratropium induced a rapid (within 1h) and significant improvement in airway function. The highest doses of both drugs had no significant effect on gastrointestinal sound score or iris function, but resulted in tacky mucous membranes and reduced gastrointestinal sound score in some horses. In Protocol 2, a cross-over design comparing the duration of action of inhaled revatropate (1mg), ipratropium (0.3mg) and saline, some indices of airway function were improved for between 5 and 6h after revatropate administration, and for between 6 and 24h after ipratropium administration. Inhaled revatropate and ipratropium had similar effects on airway function, with no significant difference between their efficacies. Importantly, however, only revatropate significantly improved clinical scores of breathing effort, improving combined clinical score at the 1h time point and abdominal score at the 1-3h time points. No significant adverse events were observed in Protocol 2, although some horses had reduced gastrointestinal sound scores. Inhaled revatropate is therefore a safe and effective bronchodilator for treating airway obstruction in heaves.

Crystallographic characterisation of binary alkali metal alkoxide-magnesium bis(alkyl) mixtures: differential binding of Na+ and K+ to a common dinuclear diorganomagnesiate.

Relevant to mixtures studied in solution and utilised in styrene polymerisation but hitherto not characterised in the solid, two crystal structures of alkali metal alkoxide-magnesium bis(alkyl) co-complexes have been determined, revealing that in binding to the C2O tripodal face of a common organomagnesiate anion, Na+ prefers O-coordination, whereas K+ prefers C-coordination.

Men, masculinity, and cancer: risk-factor behaviors, early detection, and psychosocial adaptation.

Men and women experience cancer differently. More men than women get cancer, more men than women die from cancer, and men usually adapt less well than women after a cancer diagnosis. In this article, the author suggests that the consequences of male gender-role socialization may explain some of these differences. The focus of the article is on (a) cancer risk-factor behaviors; (b) screening, early detection, symptom recognition, and help seeking; and (c) psychosocial adaptation. Research that has identified gender differences is reviewed and the impact of male gender-role socialization is offered as a potential explanation for these differences. In addition, practice implications for college health professionals are offered.

Prevalence of anticipatory nausea and emesis in cancer chemotherapy patients.

The prevalence of anticipatory nausea (AN) and anticipatory emesis (AE) in 71 cancer chemotherapy outpatients was measured by a self-report questionnaire. An 18.3% prevalence rate was found, with a mean onset of 5.12 hr prior to treatment. AN/AE most typically occurred at home or while traveling to the clinic and those who experienced it also reported a significantly higher frequency of posttreatment nausea, vomiting, constipation, and dry and itching skin.