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To DOAC or Not to DOAC for Left Ventricular Thrombi—What Is the Dose?—Reply

To DOAC or Not to DOAC for Left Ventricular Thrombi—What Is the Dose?—Reply 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 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Cardiology American Medical Association

To DOAC or Not to DOAC for Left Ventricular Thrombi—What Is the Dose?—Reply

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References (1)

Publisher
American Medical Association
Copyright
Copyright 2021 American Medical Association. All Rights Reserved.
ISSN
2380-6583
eISSN
2380-6591
DOI
10.1001/jamacardio.2020.6897
Publisher site
See Article on Publisher Site

Abstract

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

Journal

JAMA CardiologyAmerican Medical Association

Published: May 20, 2021

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