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CT January, LS Wann, H Calkins (2019)
2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons, 140
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Letters common, persistent opioid use after cardiac surgery is sig- To DOAC or Not to DOAC for Left Ventricular nificantly lower. In Canada, new persistent opioid use after Thrombi—What Is the Dose? cardiac surgery is only approximately 3% compared with To the Editor The observational study published by Robinson nearly 10% in the US. and colleagues (Retrospective Evaluation of DOACs and Vas- It has become abundantly clear that safe persistent opi- cular Endpoints of Left Ventricular Thrombi [RED VELVT] oid use can only occur as part of a comprehensive chronic pain study) provides important new data to an area that lacks a ro- management plan, and the involvement of pain specialists is bust base of evidence. Direct oral anticoagulants (DOACs) have imperative to reduce the risk of inappropriate chronic opioid become preferred pharmacotherapy options for adults with use. It is our recommendation that when a patient requests ad- nonvalvular atrial fibrillation, given the noninferiority to war- ditional opioids for postoperative pain more than 30 days af- farin for stroke prevention and superior safety profile with less ter surgery, that patient should be referred to a pain special- major bleeding. Although vitamin K antagonists (eg, warfa- ist. While the enhanced
JAMA Cardiology – American Medical Association
Published: May 20, 2021
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