Podcasts about xarelto

Agent Survival Guide Podcast

Play Episode Listen Later Sep 20, 2023 1:24

The federal government announced it has selected the first 10 drugs it will negotiate for lower prices with pharmaceutical firms. The Centers for Medicare and Medicaid Services selected the drugs, all of which are covered under Medicare Part D. The 10 drugs — Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara and Fiasp/NovoLog — accounted for .5 billion of total costs for Medicare's Part D program from June 2022 to May 2023. Medicare plans to use the cost savings to place a ,000 limit on enrollees' of out-of-pocket expenditures for drugs starting in 2026. But it could delay innovation...Article Link

medicare centers proposed prescription drugs medicaid services part d medicare part d lower prices jardiance eliquis xarelto enbrel entresto stelara imbruvica

The Procrastination Equation

Ralph Nader Radio Hour

Play Episode Listen Later Sep 9, 2023 77:35

Mark Twain once said, “Never put off till tomorrow, what you can do the day after tomorrow.” As an antidote to that Ralph welcomes Professor Piers Steel, author of “The Procrastination Equation: How to Stop Putting Things Off and Start Getting Stuff Done.” Plus, Ralph urges listeners to sign up for The Capitol Hill Citizen Association, another way to organize citizens to put pressure on the branch of our government where things must get done, the United States Congress. Dr. Piers Steel is one of the world's leading researchers and speakers on the science of motivation and procrastination. Dr. Steel is a professor in the Organizational Behaviour and Human Resources area at the University of Calgary, and is the Brookfield Research Chair at the Haskayne School of Business. He is the author of The Procrastination Equation: How to Stop Putting Things Off and Start Getting Stuff Done.The root of procrastination is impulsiveness. Impulsiveness is valuing the now more than the later… We're designed to value the now. And this was really adaptive for a long time. It's not a bad trait. It's just that we've designed a world to take advantage of every little flaw that we have in our decision-making system.Dr. Piers SteelYou have to deal with yourself as an imperfect, flawed creature and deal with the reality of that. We're not robotic angels of perfection. We have limitations. And when I actually act within my limitations, I get stuff done.Dr. Piers SteelWe're superstars of self-control in the animal kingdom. We're able to hunt and kill most anything because we're willing to actually put in the delay of gratification. That's really what makes us great. But we're still not ready for things that are happening even a year off, much less five or ten.Dr. Piers SteelMore people will listen to what we just said about becoming part of the Capitol Hill Citizen Association and say to themselves, “I'm going to get around to doing that,” than the actual number of people who do it in a prompt period of time. So it would be very good to listen to Professor Steel's suggestions and read his book, because we cannot afford procrastinatory citizens. We have a procrastinatory Congress, and the citizens have got to get them to anticipate, to foresee, to forestall so many of the omnicidal urgencies that are coming at our country and other countries around the world.Ralph NaderTo become a member of the Capitol Hill Citizen Association, click here.In Case You Haven't Heard with Francesco DeSantis1. On August 28th, 20 groups – ranging from Left-wing anti-war organizations like Veterans for Peace to Right-leaning government transparency groups like R Street Institute – sent a letter to the Chairs and Ranking Members of the House and Senate Armed Services Committees demanding they maintain Rep. Jamaal Bowman's Cost of War amendment in the final National Defense Authorization Act. This provision “requires public disclosure about the cost of the U.S.' overseas military footprint and gives the American people greater transparency on military spending.” Hopefully, the left-right consensus on this issue is enough to maintain this amendment.2. In other Pentagon news, the Intercept reports that Rep. Matt Gaetz, Republican of Florida, has introduced an amendment demanding the Pentagon “collect information on trainees who overthrow their governments,” following the recent spate of coups in Africa. Gaetz told the Intercept “The Department of Defense, up until this point, has not kept data regarding the people they train who participate in coups to overthrow democratically elected — or any — governments.” This could become a flashpoint as Congress prepares to consider the 2024 NDAA when it returns from recess in September.3. As expected, tensions are running high in Guatemala following the upset victory of anti-corruption crusader Bernardo Arevalo. Opponents of Arevalo had urged the country's electoral tribunal to suspend his Semilla party on dubious legal grounds, which the tribunal resisted hewing to the letter of the law which dictated such actions could not be taken during the electoral process. After the election however, the party was officially suspended. Now, Reuters reports that suspension has been revoked, following a mass mobilization of Arevalo supporters in Guatemala City. It seems unlikely however that Arevalo's political opponents will accept his victory without a fight.4. In a dangerous, anti-free speech move, the Attorney General of Georgia has filed RICO indictments against 42 individuals involved with the Stop Cop City protest movement, the Atlanta Community Press Collective reports. This is the latest in a long line of attempts to quash opposition to the project, which has so far included trumped up domestic terrorism charges and arrests for handing out flyers. 5. Bloomberg reports that President Biden and Brazilian President Lula will jointly call for new worker protections at the upcoming General Assembly of the United Nations. While the article notes the two leaders have been “at odds” over China and Russia, they align on the topic of labor unionization. The two presidents have found common ground before, such as on the issue of climate change.6. Visual Effects workers at Disney have filed for unionization, per the Hollywood Reporter. Approximately 80% of VFX staff have already signed union cards, demanding an NLRB election and representation by the International Alliance of Theatrical Stage Employees or IATSE. This comes on the heels of a similar announcement by VFX workers at Marvel, a Disney subsidiary. In recent years. studios have increasingly relied on VFX workers in a rather blatant attempt to cut costs, as VFX workers have generally been non-union.7. At long last, the Department of Health and Human Services has announced the first ten drugs that will be subject to Mecicare negotiations to bring down prices. These are: Eliquis, Jardiance, Xarelto, Januvia Farxiga, Entresto, Enbrel, Imbruvica, Stelara and – crucially – several brands of insulin. HHS noted that “These selected drugs accounted for $50.5 billion in total [Medicare] Part D gross covered prescription drug costs, or about 20%, of total Part D gross between June 1, 2022 and May 31, 2023.”8. The Washington Post reports Acting Labor Secretary Julie Su has proposed new overtime rules intended to “extend overtime pay to an additional 3.6 million salaried white-collar workers in the United States.” According to current rules, workers are exempt from overtime if they make over $35,568 per year; the new rules would extend to workers making under $55,000 annually. If implemented, this would mean a whole new class of workers would be eligible for time-and-a-half pay if they work more than 40 hours per week.9. Per Republic Report: “The U.S. Department of Education announced…that it is cancelling $72 million in student loan obligations for more than 2,300 former students who attended for-profit Ashford University between 2009 and 2020.” Yet, even now the shady operators behind Ashford may still be able to squeeze money out of the taxpayers via a convoluted buyout by the University of Arizona Global Campus. Still, this marks a significant victory in a legal battle that has raged for over a decade, with Senator Tom Harkin of Iowa calling Ashford a “complete scam” all the way back in 2011.10. Finally, in more debt related news, the Philadelphia Inquirer has published a piece detailing how the nonprofit RIP Medical Debt was able to purchase – and forgive – over $1.6 million in medical debt. As the piece explains “When hospitals or physician groups have delinquent debts they have little chance of collecting on, they'll typically go to what's called the secondary market and sell their portfolios for pennies on the dollar.” It was on this secondary market that RIP Medical Debt was able to buy $1.6 million worth of debt for just $17,000. In celebration, “30 proud, self-described gutter-pagan, mostly queer dirtbags in their early 30s,” gathered for a ritual burning of an oversized medical bill. Someone chanted “debt is hell” and the crowd responded “let it burn.” Get full access to Ralph Nader Radio Hour at www.ralphnaderradiohour.com/subscribe

united states american university health business china peace disney education house war africa russia joe biden marvel left cost congress veterans defense iowa republicans heard washington post united nations rico steel procrastination bloomberg guatemala pentagon calgary human resources attorney generals reuters human services mark twain chairs equation approximately opponents hollywood reporter general assembly matt gaetz vfx hhs intercept philadelphia inquirer united states congress gaetz ashford semilla visual effects ndaa national defense authorization act part d nlrb iatse guatemala city international alliance medicare part d arevalo r street institute ashford university stop cop city organizational behaviour rip medical debt impulsiveness haskayne school tom harkin jardiance eliquis xarelto theatrical stage employees arizona global campus piers steel enbrel stop putting things off entresto stelara bernardo arevalo imbruvica start getting stuff done

Vorsicht bei Pharma-Aktien

Die Börsenminute

Play Episode Listen Later Sep 4, 2023 2:58

Politisches Risiko und hoch im Kurs Wer meine Podcasts Börsenminute und GELDMEISTERIN schon länger verfolgt, weiß, dass ich Pharmaaktien für mein Langfristportfolio als eine wichtige Säule favorisiere und das tue ich auch weiterhin. Nur: durch die letzten starken Anstiege vor allem beim skandinavischen Shootingstar Novo Nordisk (Stichwort Diabetesmedikamente, die als Abnehmpille Furore machen) bin ich dabei, mein Pharma-Portfolio zu Rebalancieren, sprich einen Teil der Kursraketen zu verkaufen, um den Gesundheitstitel-Anteil und so mein Klumpenrisiko wieder zu reduzieren. Oder mir maximal die jüngsten Rohrkrepierer wie Roche zumindest genauer anzuschauen. Denn Risiko-behaftet sind Gesundheitstitel in jedem Fall und da denke ich nicht einmal an etwaige Nebenwirkungen, die in der Vergangenheit schon des Öfteren zu sündteuren Klagen geführt haben. Nein, es sind die Bewertungen, die ich teilweise nicht mehr gesund finde. Eli Lilly zum Beispiel hat in den letzten fünf Jahren um 430 Prozent zugelegt. Das Kurs-Gewinn-Verhältnis liegt bei knapp 56. Soll heißen, ich muss - aus heutiger Sicht wohlgemerkt - 56 Jahre warten, bis ich den Preis für die Aktie hereinverdient habe. Das dauert mir zu lange, auch wenn ich ihnen viel Gewinnsteigerungspotenzial noch zutraue. Man sollte keinesfalls das politische Risiko der Branche unterschätzen. Joe Biden hat gerade zehn Medikamente auf seiner Watchlist, die seinen „Inflation Reduction Act“ konterkarieren. Hier wird gerade mit Bristol-Myers, Johnson & Johnsohn, Merck, Novo Nordisk, Boehringer Ingelheim, Novartis, Amgen & Co gefeilscht, welche Preise das staatliche Gesundheitssystem künftig nur noch für die Arznei bereit ist zu bezahlen und das ist nicht unerheblich. Zum einen, schreibt die Financial Times, droht ihnen eine Besteuerung von 65 bis 95 Prozent, zum anderen ein Ausschluss aus dem Gesundheitsprogramm Medicare, was tragisch wäre, da es teilweise zu 50 Prozent ihre Umsätze in den USA sichert. Die konkreten Medikamente, deren Preise für Biden´s Geschmack zu hoch sind, findet ihr hier im Beipackzettel zu dieser Börsenminute: • Eliquis von Bristol-Myers Squibb (NYSE:BMY); • Jardiance von Boehringer Ingelheim; • Xarelto von Johnson & Johnson (NYSE:JNJ); • Januvia von Merck (NYSE:MRK); • Farxiga von AstraZeneca (NASDAQ:AZN); • Entresto von Novartis (NYSE:NVS); • Enbrel von Amgen (NASDAQ:AMGN); • Imbruvica von AbbVie (NYSE:ABBV); • Stelara von Janssen (im Besitz von JNJ); • Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog PenFill von Novo Nordisk (NYSE:NVO). Rechtshinweis: Dies ist die Meinunung der Autorin und keine Anlageempfehlung. Was ihr daraus macht ist Eure Sache, Julia Kistner übernimmt hierfür keine Haftung. #Börse #investment #Pharmatitel #Inflationreductionact #Aktien #podcast Foto: Unsplash

CMS Unveils First Medicare Drug Price Negotiation List

Play Episode Listen Later Sep 1, 2023 13:35

Unpacking the first Medicare drug price negotiation list, the NAIFA, FSP, and Life Happens merger, Apple's Wonderlust Event and more! Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim Twitter, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Resources: 4 Effective Techniques for Closing Insurance Sales: https://agentsurvivalguide.podbean.com/e/4-effective-techniques-for-closing-insurance-sales/ Best Practices for Conducting an Interview featuring Dylan Cook: https://agentsurvivalguide.podbean.com/e/best-practices-for-conducting-an-interview-featuring-dylan-cook/ CMS Announces First 10 Drugs for Medicare Drug Price Negotiation: https://www.ritterim.com/blog/cms-announces-first-10-drugs-for-medicare-drug-price-negotiation/ How to Overcome Common Insurance Sales Objections ft. Dan Ford: https://agentsurvivalguide.podbean.com/e/how-to-overcome-common-insurance-sales-objections-ft-dan-ford/ Understanding the C-SNP Product & Opportunity ft. Ben Miller (Zing Health): https://agentsurvivalguide.podbean.com/e/understanding-the-c-snp-product-opportunity-ft-ben-miller-zing-health/ References: 5 actual clues in Apple's iPhone 15 Wonderlust event invite: https://www.macworld.com/article/2046187/wonderlust-event-invite-clues-colors-apple-watch-iphone-15-airpods.html Apple announces the iPhone 15 launch event: https://www.theverge.com/2023/8/29/23819494/apple-september-event-iphone-15-pro-watch-ultra-date Apple Events: https://www.apple.com/apple-events/ Blood thinners, diabetes meds among first 10 drugs for US price negotiations: https://www.reuters.com/business/healthcare-pharmaceuticals/us-name-first-10-drugs-medicare-price-negotiation-2023-08-29/ Eliquis, Jardiance, Xarelto headline CMS' price negotiation list: https://www.fiercehealthcare.com/payers/eliquis-jardiance-xarelto-headline-cms-price-negotiated-drug-list Factsheet: Medicare Drug Price Negotiation Program: https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf HHS Selects the First Drugs for Medicare Drug Price Negotiation: https://www.hhs.gov/about/news/2023/08/29/hhs-selects-the-first-drugs-for-medicare-drug-price-negotiation.html Medicare Price Negotiation: Ten Drugs That Made the List, and Ten That Should Have: https://prospect.org/health/2023-08-30-medicare-price-negotiation-first-ten-drugs/ NAIFA, FSP and Life Happens announce plan to unite: https://insurancenewsnet.com/innarticle/naifa-fsp-and-life-happens-announce-plan-to-unite Strike Force Five: https://open.spotify.com/show/3YnUJC2alA6I1F2V7CdDa2?si=781e5bb1354e4406 The Late-Night Dudes Are Doing a Daytime Pod: https://www.vulture.com/article/late-night-hosts-podcast-strike-force-five.html

August 30, 2023 - Heartland Pod Politics Wednesday - 2024 Elections and Government News

Heartland POD

Play Episode Listen Later Aug 30, 2023 26:31

Florida Gov and GOP 2024 also-ran Ron DeSantis looks to lead in wake of violence and major hurricane | Former SC Gov and UN Ambassador under President Trump, Nikki Haley is having a moment, kind of | President Biden names first 10 drugs subject to negotations with Medicare | 60th anniversary of the March on WashingtonSong playsIntro by hostWelcome to Heartland Pod Wednesday!Support this show and all the work in the Heartland POD universe by going to heartlandpod.com and clicking the link for Patreon, or go to Patreon.com/HeartlandPod to sign up. Membership starts at $1/month, with even more extra shows and special access at the higher levels. No matter the level you choose, your membership helps us create these independent shows as we work together to change the conversation.Alright! Let's get into it: Hurricane in Florida / Shooting in FloridaPOLITICO: DeSantis knows how to handle a hurricane. The racist shooting poses a bigger dilemma.A racially-motivated Jacksonville tragedy, couple with a looming storm, pose big tests for the governor.Florida Gov. Ron DeSantis, center and his wife Casey, right, bow their heads during a prayer.Florida Gov. Ron DeSantis (center) and his wife Casey bow their heads during a prayer at a vigil for the victims of Saturday's mass shooting on Sunday, Aug. 27, 2023, in Jacksonville. | John Raoux/AP PhotoBy KIMBERLY LEONARD08/28/2023 04:14 PM EDTUpdated: 08/28/2023 05:12 PM EDTMIAMI — Florida Gov. Ron DeSantis' handling of back-to-back crises — a racist mass shooting and a potentially catastrophic hurricane — could help burnish his image as a can-do, effective governor or further damage his standing with Black Americans who have grown livid over his policies.Already, DeSantis' attempts to show leadership in the immediate aftermath of the Saturday shooting were poorly received by some Black lawmakers, Democrats and residents in Florida. In the hours after a 21-year-old white man killed three Black Floridians near a historically Black college in Jacksonville, several state Democrats blamed DeSantis, who is running for president, for creating an environment, through policies such as loosening gun laws and ending diversity programs, that helped hate fester.DeSantis has condemned the shooting and said “targeting people due to their race has no place in this state of Florida.” But attending a Sunday night vigil in Jacksonville, he was jeered and booed by people who had come out to remember the victims. At one point, a Jacksonville Democratic councilmember stepped in to calm the crowd, urging people to “put parties aside.” Later during the event, a pastor took issue with DeSantis describing the gunman as a “scumbag,” and said he should have used the word “racist” instead.The vigil stood in contrast to press conferences in Tallahassee on Sunday and Monday, when DeSantis appeared visibly tired but spoke authoritatively about preparations overseeing Tropical Storm Idalia, which is forecast to become a major hurricane. He canceled campaign appearances and fundraisers, and told Floridians Sunday they could “rest assured” because “I am here” and would “get the job done.”DeSantis says politics won't interfere with storm response“He needs to be in Florida for as long as it takes,” said Adam Hollingsworth, the former chief of staff to Sen. Rick Scott (R-Fla.), who served as governor before DeSantis. “His presidential ambitions could be a distraction, but first Gov. DeSantis has to dance with the one who brought him. Right now, that's the people of Florida.”Though the shooting and looming storm are taking DeSantis away from campaigning for president following a high-profile debate, they'll also allow voters and donors to see the governor at work leading the hurricane response, letting the public assess how he balances multiple priorities, displays empathy and projects leadership in moments of tragedy. At the same time, the shooting has shined a spotlight on DeSantis' record and vulnerabilities on race, one of the areas for which he has faced the most criticism and controversy as governor.In times of tragedy, opponents are “looking for a misstep,” acknowledged Craig Fugate, who led Florida's emergency division under Gov. Jeb Bush and oversaw FEMA during the Obama administration.“They're looking for something to go wrong — particularly for the opponents; they're looking for something to capitalize on,” Fugate said.DeSantis began his Monday morning hurricane preparedness press conference by first addressing the mass shooting. He pledged $1 million in security funding to Edward Waters University, a historically Black university that the gunman is believed to have initially targeted, as well as $100,000 toward a charity for the families of the victims. He also deployed state law enforcement officials to evaluate the campus' security and make additional recommendations, pledging to continue to assist in the “days and weeks ahead.”But many Democrats in the state panned his response. They pointed to laws he enacted in Florida to carve up representation in a Black-majority district that eventually led a Black Democratic congressman, Rep. Al Lawson, to lose his seat. They also pointed to his policies, approved by the GOP-led Legislature, banning what he calls “critical race theory” in schools, as well as his defense of a public school curriculum on Black history that required middle-school teachers to instruct that enslaved people “developed skills which, in some instances, could be applied for their personal benefit.”Florida Minority House Leader Fentrice Driskell, a Black Democrat of Tampa, said it was “absolutely” the right decision for DeSantis to attend the vigil but added that she didn't want to give him a pass.“The reality is, a number of wrongheaded decisions about the state of Florida, and who we are as a people, I think contributed to this charged political climate that resulted in the violence that we saw,” Driskell said in an interview.The accused gunman, identified as Ryan Palmeter, had a racist manifesto and drew swastikas on his weapons. He also had a history of mental illness, having been involuntarily institutionalized for emergency mental health services as a teenager, police said.During DeSantis' vigil remarks Sunday, Democratic state Rep. Angela Nixon, who represents the district where the shooting took place, could be seen glaring at the governor in videos and photos widely shared on social media.“We feel the same,” the NAACP wrote on X, the social media platform formerly known as Twitter.AXIOS: Biden set to name first 10 drugs subject to Medicare negotiations.The blood-thinners Eliquis and Xarelto are among the 10 prescription medicines the Biden administration will seek lower Medicare prices for as part of a new program allowing the government to negotiate drug prices for America's seniors.Why it matters: The administration's landmark announcement Tuesday detailed the first-ever set of drugs subject to Medicare price negotiations, a longtime Democratic priority included in last year's Inflation Reduction Act over drug companies' fervent objections.Other drugs up for negotiation include:Jardiance, a diabetes drug.Januvia, also for diabetes.Farxiga, another diabetes drug.Entresto, for heart failure.Enbrel, for arthritis and psoriasis.Imbruvica, a blood cancer drug.Stelara, used on psoriasis, Crohn's disease and other illnesses.Fiasp, also used for diabetes.Of note: Insulin is already subject to a $35 monthly co-pay cap for Medicare prescription drug plan enrollees under a different provision of the IRA.State of play: The drugs' manufacturers will have just over a month to decide whether to participate in negotiations — which the industry is battling in court — or sit out the process, at the risk of significant financial penalty.Drugmakers who refuse to negotiate with Medicare face an excise tax of up to 95% of their U.S. sales, or they can withdraw their drugs from Medicare and Medicaid coverage, shutting them out of huge markets.What they're saying: "The cancer moonshot will not succeed if this administration continues to dismantle the innovation rocket we need to get there," Stephen Ubl, CEO of industry trade group PhRMA, said in a statement following the release of the list.Zoom out: The medicines up for negotiation were chosen from a list of the 50 products with the highest spending in Medicare's prescription drug program, Part D.The selected drugs accounted for 20% of Part D prescription costs between June 1, 2022 and May 31, 2023, according to the Health and Human Services Department.Some of the highest-cost Medicare drugs were not eligible for this round of negotiations, either because they still have market exclusivity, they're the only option for a rare disease or another factor.The prices won't take effect before the 2024 elections, but Democrats are expected to tout the negotiations, along with other drug cost reforms in the IRA, as part of their campaign messaging.What's next: The Centers for Medicare and Medicaid Services will submit price offers to the drug companies by Feb. 1, with negotiations continuing until next August.CMS will publish the drugs' final maximum fair prices by Sept. 1, 2024, and prices will go into effect in 2026.What we're watching: Ongoing legal challenges could draw out or halt the negotiation process.Drugmakers and allied groups have already filed eight lawsuits against the Medicare drug negotiation process, and more lawsuits could follow Tuesday's announcement.President Biden and his health officials committed this morning to fighting industry lawsuits."Let me be clear: I am not backing down. There is no reason why Americans should be forced to pay more than any developed nation for life-saving prescriptions just to pad Big Pharma's pockets," Biden said in a statement.Nikki HaleyDAILY BEAST: Is it time for Republicans to take Nikki Haley seriously?According to a new Emerson College Polling survey, “Haley saw the largest increase in support among Republican candidates, jumping 5 points from 2 percent to 7 percent” following last week's debate.“Nikki Haley's support increased from about 2 percent to 9 percent among voters over 50 [years of age],” said Spencer Kimball, executive director of Emerson College Polling, “while Trump's support dropped within this age group from about 56 percent to 49 percent after the debate.”Republican Debaters Agreed on One Thing: They Hate Vivek RamaswamyThis jump is modest, inasmuch as it still leaves Haley in the single digits. But it's also no outlier. According to a poll conducted by The Washington Post, FiveThirtyEight, and Ipsos released last Thursday, voters were persuaded to at least give her a second look. “Pre-debate, 29 percent of GOP primary voters who watched the debate said they were considering voting for her,” according to the survey, “and that increased to 46 percent after the debate.”So how did she do it? Haley caught our attention by being first to hit Trump (from the right), when she criticized him for “adding eight trillion to our debt.” This surprised everyone, demonstrated courage, and put to rest the notion that she is merely running to be Trump's vice president.Haley also staked out a strong position on abortion. While stressing her pro-life beliefs, she made the pragmatic case that a federal abortion ban would require 60 votes. Instead, Haley urged Republicans to focus on consensus issues, like banning late-term abortions, making sure contraception is widely available, and supporting adoption as an alternative.Trump's former veep, Mike Pence, who supports a 15-week federal ban on abortion, took umbrage with this. “Nikki, you're my friend, but consensus is the opposite of leadership,” Pence scolded. (As the Never Trump conservative writer Jonah Goldberg has pointed out on his podcast, building consensus is often a key attribute of leadership.)The Republican Debate Was a Futile Pudding Wrestling MatchThis exchange, like others during that same debate, made it clear that in a general election Nikki Haley would likely be Joe Biden's most challenging opponent.Having served as governor of South Carolina and ambassador to the United Nations, she has the experience needed for the office. She also has sharp elbows. (“You have no foreign policy experience and it shows,” she told Vivek Ramaswamy.)At 51, Haley would present a stark contrast in terms of generational change, assuming that Joe Biden was still the Democratic nominee. And (unlike others) she is not staking out an abortion position that might render her effectively unelectable, should she become the Republican nominee.Haley (who frequently cites Margaret Thatcher's line, “If you want something said, ask a man. If you want something done, ask a woman”) was the only woman on that stage. Her identity, temperament, and policy positions could help chip away at the gender gap that has only grown in recent years.The obvious caveat here is that all of these things would make Haley a great candidate to beat Joe Biden if she somehow wins the Republican nomination. But that's an awfully big “if.”Kareem Abdul-Jabbar: GOP Debate Showed How Not to Pick a PresidentHaley's answer to this is to make the electability argument: “We have to face the fact that Trump is the most disliked politician in America,” she—and she, alone—averred during last week's debate.But will that dog hunt?Right now, the electability argument isn't persuading Republicans to jump off the Trump bandwagon, even though that argument is likely the only one that could ever work. At some point (perhaps after Donald Trump goes on trial and it's too late), Republicans might be convinced that, as entertaining as Trump is, he simply can't win.Based on all of this, you might expect me to suggest that it's time to clear the field—to rally every freedom conservative, Reagan Republican, and Never Trump conservative to coalesce around Haley as the GOP's last, best hope.Some of my colleagues are already there. The New York Times columnist David Brooks, for example, declared last week that “Wednesday's debate persuaded me that the best Trump alternative is not [Tim] Scott, it's Nikki Haley.”But here's my problem. Haley has been all over the map for years now. One day she's courageous and impressive, and the next day she's a pathetic Trump toady.Haley is a political chameleon, which makes me reluctant to ever trust her again.Trump and Ramaswamy Show Us How the Worst Get to the TopOn the other hand, anyone looking for purity (as it pertains to Trump) can also dismiss Pence and Chris Christie—both of whom supported Trump until Jan. 6—and a vast swath of today's leading Never Trumpers. As the Good Book says, “Who then can be saved?”Nikki Haley's got a long way to go before she clears the not-Trump lane of candidates, much less taking on the final boss himself. And though nothing has yet made a dent in Trump's domination of the GOP voter base, he's never run as a candidate on trial before. But the whole 91-felony indictment thing might just do the trick.If Haley can prove herself by stringing together two or three of these kinds of courageous performances—in which she not only characterizes Trump as the guy who already lost to Biden, but also that she's as real a conservative as any of the other contenders—there is a path to success.It's hardly guaranteed, and as I've noted, courage comes and goes with Haley. But in the “Matt Lewis primary,” you can count me among the 46 percent who are now considering voting for her.Read more at The Daily Beast.SEMAFOR: Nikki Haley's abortion message could catch on in the GOPMorgan Chalfant and Kadia GobaRepublicans worried about Democrats leveraging abortion (again) to make gains in 2024 want GOP candidates to take a page out of Nikki Haley's debate prep playbook.Haley dismissed the idea that a 15-week national abortion ban could pass through Congress. Instead, she argued the focus should be on finding “consensus” around banning “late-term abortions,” sustaining access to contraception, allowing doctors who don't support abortion refuse to perform them, and preventing women who get abortions from being penalized.Defeated Michigan gubernatorial candidate Tudor Dixon bluntly said on Fox News that Republicans would lose the messaging war in 2024 unless they followed Haley's “perfect response” in the debate.“No one really understood how important abortion would be in 2022 because no one had run in a post-Roe world, so we suddenly got attacked, viciously attacked, by the Democrats, and it is a winning message for them,” she said. Gov. Gretchen Whitmer highlighted Dixon's opposition to rape exceptions in abortion bans in their contest, which took place alongide a ballot initiative guaranteeing abortion rights that passed by a wide margin.“The only candidate on the stage that talked about how we should protect women and not demonize them was Nikki Haley,” Rep. Nancy Mace, R-S.C. said Sunday on CBS of the first GOP presidential debate. “And that is a message that we have to carry through. We have to be pro-woman and pro-life. You cannot go after women and attack them because they make a choice that you don't like or don't agree with.”And Rep. George Santos, R-N.Y., who represents a district President Biden won in 2020, told Semafor at a watch party last week: “She had probably the best-packaged message on abortion that I've heard, I want to say, in my entire adult life.”Haley might have won herself some fans, but her position wasn't a favorite within the anti-abortion movement, which has rallied around a 15-week federal ban as a minimum ask for candidates.

america ceo black health donald trump politics state americans new york times zoom joe biden elections government barack obama congress south carolina republicans cbs washington post democrats roe v wade hurricanes abortion tampa united nations fox news democratic jacksonville membership medicare gop centers gov ongoing rn ron desantis mike pence black americans dixon medicaid big pharma fema naacp crohn rs insulin cms inflation reduction act heartland tallahassee florida legislature nikki haley margaret thatcher daily beast george santos vivek ramaswamy chris christie tim scott abortion rights gretchen whitmer good books david brooks ipsos fivethirtyeight rick scott jeb bush nancy mace medicaid services part d 2024 elections never trumpers never trump matt lewis jonah goldberg un ambassador fugate tudor dixon driskell human services department florida shooting phrma spencer kimball and rep jardiance eliquis xarelto craig fugate tropical storm idalia reagan republicans enbrel black democratic entresto stelara imbruvica

August 30, 2023 - Heartland Pod Politics Wednesday - 2024 Elections and Government News

The Heartland POD

Play Episode Listen Later Aug 30, 2023 26:31

Florida Gov and GOP 2024 also-ran Ron DeSantis looks to lead in wake of violence and major hurricane | Former SC Gov and UN Ambassador under President Trump, Nikki Haley is having a moment, kind of | President Biden names first 10 drugs subject to negotations with Medicare | 60th anniversary of the March on WashingtonSong playsIntro by hostWelcome to Heartland Pod Wednesday!Support this show and all the work in the Heartland POD universe by going to heartlandpod.com and clicking the link for Patreon, or go to Patreon.com/HeartlandPod to sign up. Membership starts at $1/month, with even more extra shows and special access at the higher levels. No matter the level you choose, your membership helps us create these independent shows as we work together to change the conversation.Alright! Let's get into it: Hurricane in Florida / Shooting in FloridaPOLITICO: DeSantis knows how to handle a hurricane. The racist shooting poses a bigger dilemma.A racially-motivated Jacksonville tragedy, couple with a looming storm, pose big tests for the governor.Florida Gov. Ron DeSantis, center and his wife Casey, right, bow their heads during a prayer.Florida Gov. Ron DeSantis (center) and his wife Casey bow their heads during a prayer at a vigil for the victims of Saturday's mass shooting on Sunday, Aug. 27, 2023, in Jacksonville. | John Raoux/AP PhotoBy KIMBERLY LEONARD08/28/2023 04:14 PM EDTUpdated: 08/28/2023 05:12 PM EDTMIAMI — Florida Gov. Ron DeSantis' handling of back-to-back crises — a racist mass shooting and a potentially catastrophic hurricane — could help burnish his image as a can-do, effective governor or further damage his standing with Black Americans who have grown livid over his policies.Already, DeSantis' attempts to show leadership in the immediate aftermath of the Saturday shooting were poorly received by some Black lawmakers, Democrats and residents in Florida. In the hours after a 21-year-old white man killed three Black Floridians near a historically Black college in Jacksonville, several state Democrats blamed DeSantis, who is running for president, for creating an environment, through policies such as loosening gun laws and ending diversity programs, that helped hate fester.DeSantis has condemned the shooting and said “targeting people due to their race has no place in this state of Florida.” But attending a Sunday night vigil in Jacksonville, he was jeered and booed by people who had come out to remember the victims. At one point, a Jacksonville Democratic councilmember stepped in to calm the crowd, urging people to “put parties aside.” Later during the event, a pastor took issue with DeSantis describing the gunman as a “scumbag,” and said he should have used the word “racist” instead.The vigil stood in contrast to press conferences in Tallahassee on Sunday and Monday, when DeSantis appeared visibly tired but spoke authoritatively about preparations overseeing Tropical Storm Idalia, which is forecast to become a major hurricane. He canceled campaign appearances and fundraisers, and told Floridians Sunday they could “rest assured” because “I am here” and would “get the job done.”DeSantis says politics won't interfere with storm response“He needs to be in Florida for as long as it takes,” said Adam Hollingsworth, the former chief of staff to Sen. Rick Scott (R-Fla.), who served as governor before DeSantis. “His presidential ambitions could be a distraction, but first Gov. DeSantis has to dance with the one who brought him. Right now, that's the people of Florida.”Though the shooting and looming storm are taking DeSantis away from campaigning for president following a high-profile debate, they'll also allow voters and donors to see the governor at work leading the hurricane response, letting the public assess how he balances multiple priorities, displays empathy and projects leadership in moments of tragedy. At the same time, the shooting has shined a spotlight on DeSantis' record and vulnerabilities on race, one of the areas for which he has faced the most criticism and controversy as governor.In times of tragedy, opponents are “looking for a misstep,” acknowledged Craig Fugate, who led Florida's emergency division under Gov. Jeb Bush and oversaw FEMA during the Obama administration.“They're looking for something to go wrong — particularly for the opponents; they're looking for something to capitalize on,” Fugate said.DeSantis began his Monday morning hurricane preparedness press conference by first addressing the mass shooting. He pledged $1 million in security funding to Edward Waters University, a historically Black university that the gunman is believed to have initially targeted, as well as $100,000 toward a charity for the families of the victims. He also deployed state law enforcement officials to evaluate the campus' security and make additional recommendations, pledging to continue to assist in the “days and weeks ahead.”But many Democrats in the state panned his response. They pointed to laws he enacted in Florida to carve up representation in a Black-majority district that eventually led a Black Democratic congressman, Rep. Al Lawson, to lose his seat. They also pointed to his policies, approved by the GOP-led Legislature, banning what he calls “critical race theory” in schools, as well as his defense of a public school curriculum on Black history that required middle-school teachers to instruct that enslaved people “developed skills which, in some instances, could be applied for their personal benefit.”Florida Minority House Leader Fentrice Driskell, a Black Democrat of Tampa, said it was “absolutely” the right decision for DeSantis to attend the vigil but added that she didn't want to give him a pass.“The reality is, a number of wrongheaded decisions about the state of Florida, and who we are as a people, I think contributed to this charged political climate that resulted in the violence that we saw,” Driskell said in an interview.The accused gunman, identified as Ryan Palmeter, had a racist manifesto and drew swastikas on his weapons. He also had a history of mental illness, having been involuntarily institutionalized for emergency mental health services as a teenager, police said.During DeSantis' vigil remarks Sunday, Democratic state Rep. Angela Nixon, who represents the district where the shooting took place, could be seen glaring at the governor in videos and photos widely shared on social media.“We feel the same,” the NAACP wrote on X, the social media platform formerly known as Twitter.AXIOS: Biden set to name first 10 drugs subject to Medicare negotiations.The blood-thinners Eliquis and Xarelto are among the 10 prescription medicines the Biden administration will seek lower Medicare prices for as part of a new program allowing the government to negotiate drug prices for America's seniors.Why it matters: The administration's landmark announcement Tuesday detailed the first-ever set of drugs subject to Medicare price negotiations, a longtime Democratic priority included in last year's Inflation Reduction Act over drug companies' fervent objections.Other drugs up for negotiation include:Jardiance, a diabetes drug.Januvia, also for diabetes.Farxiga, another diabetes drug.Entresto, for heart failure.Enbrel, for arthritis and psoriasis.Imbruvica, a blood cancer drug.Stelara, used on psoriasis, Crohn's disease and other illnesses.Fiasp, also used for diabetes.Of note: Insulin is already subject to a $35 monthly co-pay cap for Medicare prescription drug plan enrollees under a different provision of the IRA.State of play: The drugs' manufacturers will have just over a month to decide whether to participate in negotiations — which the industry is battling in court — or sit out the process, at the risk of significant financial penalty.Drugmakers who refuse to negotiate with Medicare face an excise tax of up to 95% of their U.S. sales, or they can withdraw their drugs from Medicare and Medicaid coverage, shutting them out of huge markets.What they're saying: "The cancer moonshot will not succeed if this administration continues to dismantle the innovation rocket we need to get there," Stephen Ubl, CEO of industry trade group PhRMA, said in a statement following the release of the list.Zoom out: The medicines up for negotiation were chosen from a list of the 50 products with the highest spending in Medicare's prescription drug program, Part D.The selected drugs accounted for 20% of Part D prescription costs between June 1, 2022 and May 31, 2023, according to the Health and Human Services Department.Some of the highest-cost Medicare drugs were not eligible for this round of negotiations, either because they still have market exclusivity, they're the only option for a rare disease or another factor.The prices won't take effect before the 2024 elections, but Democrats are expected to tout the negotiations, along with other drug cost reforms in the IRA, as part of their campaign messaging.What's next: The Centers for Medicare and Medicaid Services will submit price offers to the drug companies by Feb. 1, with negotiations continuing until next August.CMS will publish the drugs' final maximum fair prices by Sept. 1, 2024, and prices will go into effect in 2026.What we're watching: Ongoing legal challenges could draw out or halt the negotiation process.Drugmakers and allied groups have already filed eight lawsuits against the Medicare drug negotiation process, and more lawsuits could follow Tuesday's announcement.President Biden and his health officials committed this morning to fighting industry lawsuits."Let me be clear: I am not backing down. There is no reason why Americans should be forced to pay more than any developed nation for life-saving prescriptions just to pad Big Pharma's pockets," Biden said in a statement.Nikki HaleyDAILY BEAST: Is it time for Republicans to take Nikki Haley seriously?According to a new Emerson College Polling survey, “Haley saw the largest increase in support among Republican candidates, jumping 5 points from 2 percent to 7 percent” following last week's debate.“Nikki Haley's support increased from about 2 percent to 9 percent among voters over 50 [years of age],” said Spencer Kimball, executive director of Emerson College Polling, “while Trump's support dropped within this age group from about 56 percent to 49 percent after the debate.”Republican Debaters Agreed on One Thing: They Hate Vivek RamaswamyThis jump is modest, inasmuch as it still leaves Haley in the single digits. But it's also no outlier. According to a poll conducted by The Washington Post, FiveThirtyEight, and Ipsos released last Thursday, voters were persuaded to at least give her a second look. “Pre-debate, 29 percent of GOP primary voters who watched the debate said they were considering voting for her,” according to the survey, “and that increased to 46 percent after the debate.”So how did she do it? Haley caught our attention by being first to hit Trump (from the right), when she criticized him for “adding eight trillion to our debt.” This surprised everyone, demonstrated courage, and put to rest the notion that she is merely running to be Trump's vice president.Haley also staked out a strong position on abortion. While stressing her pro-life beliefs, she made the pragmatic case that a federal abortion ban would require 60 votes. Instead, Haley urged Republicans to focus on consensus issues, like banning late-term abortions, making sure contraception is widely available, and supporting adoption as an alternative.Trump's former veep, Mike Pence, who supports a 15-week federal ban on abortion, took umbrage with this. “Nikki, you're my friend, but consensus is the opposite of leadership,” Pence scolded. (As the Never Trump conservative writer Jonah Goldberg has pointed out on his podcast, building consensus is often a key attribute of leadership.)The Republican Debate Was a Futile Pudding Wrestling MatchThis exchange, like others during that same debate, made it clear that in a general election Nikki Haley would likely be Joe Biden's most challenging opponent.Having served as governor of South Carolina and ambassador to the United Nations, she has the experience needed for the office. She also has sharp elbows. (“You have no foreign policy experience and it shows,” she told Vivek Ramaswamy.)At 51, Haley would present a stark contrast in terms of generational change, assuming that Joe Biden was still the Democratic nominee. And (unlike others) she is not staking out an abortion position that might render her effectively unelectable, should she become the Republican nominee.Haley (who frequently cites Margaret Thatcher's line, “If you want something said, ask a man. If you want something done, ask a woman”) was the only woman on that stage. Her identity, temperament, and policy positions could help chip away at the gender gap that has only grown in recent years.The obvious caveat here is that all of these things would make Haley a great candidate to beat Joe Biden if she somehow wins the Republican nomination. But that's an awfully big “if.”Kareem Abdul-Jabbar: GOP Debate Showed How Not to Pick a PresidentHaley's answer to this is to make the electability argument: “We have to face the fact that Trump is the most disliked politician in America,” she—and she, alone—averred during last week's debate.But will that dog hunt?Right now, the electability argument isn't persuading Republicans to jump off the Trump bandwagon, even though that argument is likely the only one that could ever work. At some point (perhaps after Donald Trump goes on trial and it's too late), Republicans might be convinced that, as entertaining as Trump is, he simply can't win.Based on all of this, you might expect me to suggest that it's time to clear the field—to rally every freedom conservative, Reagan Republican, and Never Trump conservative to coalesce around Haley as the GOP's last, best hope.Some of my colleagues are already there. The New York Times columnist David Brooks, for example, declared last week that “Wednesday's debate persuaded me that the best Trump alternative is not [Tim] Scott, it's Nikki Haley.”But here's my problem. Haley has been all over the map for years now. One day she's courageous and impressive, and the next day she's a pathetic Trump toady.Haley is a political chameleon, which makes me reluctant to ever trust her again.Trump and Ramaswamy Show Us How the Worst Get to the TopOn the other hand, anyone looking for purity (as it pertains to Trump) can also dismiss Pence and Chris Christie—both of whom supported Trump until Jan. 6—and a vast swath of today's leading Never Trumpers. As the Good Book says, “Who then can be saved?”Nikki Haley's got a long way to go before she clears the not-Trump lane of candidates, much less taking on the final boss himself. And though nothing has yet made a dent in Trump's domination of the GOP voter base, he's never run as a candidate on trial before. But the whole 91-felony indictment thing might just do the trick.If Haley can prove herself by stringing together two or three of these kinds of courageous performances—in which she not only characterizes Trump as the guy who already lost to Biden, but also that she's as real a conservative as any of the other contenders—there is a path to success.It's hardly guaranteed, and as I've noted, courage comes and goes with Haley. But in the “Matt Lewis primary,” you can count me among the 46 percent who are now considering voting for her.Read more at The Daily Beast.SEMAFOR: Nikki Haley's abortion message could catch on in the GOPMorgan Chalfant and Kadia GobaRepublicans worried about Democrats leveraging abortion (again) to make gains in 2024 want GOP candidates to take a page out of Nikki Haley's debate prep playbook.Haley dismissed the idea that a 15-week national abortion ban could pass through Congress. Instead, she argued the focus should be on finding “consensus” around banning “late-term abortions,” sustaining access to contraception, allowing doctors who don't support abortion refuse to perform them, and preventing women who get abortions from being penalized.Defeated Michigan gubernatorial candidate Tudor Dixon bluntly said on Fox News that Republicans would lose the messaging war in 2024 unless they followed Haley's “perfect response” in the debate.“No one really understood how important abortion would be in 2022 because no one had run in a post-Roe world, so we suddenly got attacked, viciously attacked, by the Democrats, and it is a winning message for them,” she said. Gov. Gretchen Whitmer highlighted Dixon's opposition to rape exceptions in abortion bans in their contest, which took place alongide a ballot initiative guaranteeing abortion rights that passed by a wide margin.“The only candidate on the stage that talked about how we should protect women and not demonize them was Nikki Haley,” Rep. Nancy Mace, R-S.C. said Sunday on CBS of the first GOP presidential debate. “And that is a message that we have to carry through. We have to be pro-woman and pro-life. You cannot go after women and attack them because they make a choice that you don't like or don't agree with.”And Rep. George Santos, R-N.Y., who represents a district President Biden won in 2020, told Semafor at a watch party last week: “She had probably the best-packaged message on abortion that I've heard, I want to say, in my entire adult life.”Haley might have won herself some fans, but her position wasn't a favorite within the anti-abortion movement, which has rallied around a 15-week federal ban as a minimum ask for candidates.

america ceo black health donald trump politics state americans new york times zoom joe biden elections government barack obama congress south carolina republicans cbs washington post democrats roe v wade hurricanes abortion tampa united nations fox news democratic jacksonville membership medicare gop centers gov ongoing rn ron desantis mike pence black americans dixon medicaid big pharma fema naacp crohn rs insulin cms inflation reduction act heartland tallahassee florida legislature nikki haley margaret thatcher daily beast george santos vivek ramaswamy chris christie tim scott abortion rights gretchen whitmer good books david brooks ipsos fivethirtyeight rick scott jeb bush nancy mace medicaid services part d 2024 elections never trumpers never trump matt lewis jonah goldberg un ambassador fugate tudor dixon driskell human services department florida shooting phrma spencer kimball and rep jardiance eliquis xarelto craig fugate tropical storm idalia reagan republicans enbrel black democratic entresto stelara imbruvica

Indignity Morning Podcast No. 135: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, Fiasp and NovoLog.

INDIGNITY MORNING PODCAST

Play Episode Listen Later Aug 30, 2023 4:20

Our transcription service is still very BETA. Get full access to INDIGNITY at indignity.substack.com/subscribe

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New smoking cessation drug trials show promise for individuals aiming to quit smoking

Steve Cochran on The Big 89

Play Episode Listen Later Jul 18, 2023 14:48

Northwestern Medicine Chief Medical Officer Dr. Kevin Most joins the Steve Cochran Show to discuss a new smoking cessation drug that may be hitting the market soon, over-the-counter birth control that may be available as soon as 2024, and the potential long-term health implications associated with Ozempic usage. Dr. Kevin Most's Show Notes: Over-the-counter oral contraceptive pill FDA approved. On Thursday the FDA approved the first OTC birth control pill. Drastic change? There are 100 other countries that already have this in place, so we are lagging not cutting edge The drug named Opill has been safely used for years across the world The medication is expected to be available in January and will not have an age restriction Will be interesting to see the pricing and if insurance companies will cover the cost. The medication is sometimes called a “mini pill” it has progestin, it suppresses ovulation The FDA voted unanimously that the benefits outweigh the risks There is obviously the political as well as religious concerns It is not uncommon for a drug to go from prescription to OTC (Aleve, Nexium, Pepcid, Zyrtec) Drug for smoking cessation does well in clinical trial Smoking cessation has always been a difficult thing to accomplish Many things have been tried- nicotine patch, nicotine gum, antidepressants, acupuncture, hypnosis- most with little or no success Currently a Phase 3 study on a drug historically known as Cytisine being done at Mass General Results out in JAMA recently are very positive- effective and well tolerated Cytisine is a natural plant based compound that binds to the nicotine receptors in the brain that slow the urge to smoke This is better than the slow decline in nicotine replacement This was done at 17 sites with over 800 participants with the end goal being total stopping of smoking for a 4 week period Individuals in the trial noted a rapid and sustained decline in the craving and smoking urges in the first month Over the long term it continued to show great success at the 6 month mark Well tolerated with low rates of side effects Drug information- Drugs have a patent life where no generics can be made and a company has the exclusive rights to produce and sell the drug The patent life for a drug is 20 years from the date the patent was submitted, however there are extensions for antibiotics, some pediatric drugs, orphan drugs The patent does not mean that a company has 20 years of sales without a competitor as some of these drugs will take 10-15 years to go thru the trails necessary for approval There are 51 drugs coming off patent in 2023 including billion dollar drugs used to treat diabetes, depression, arthritis, ADHD If you are taking a brand name drug and want to see when it will come off patent Pharsight is a great resource Drug shortages- safety lapses- razor thin margins- tough competition Drug shortages in the US are at the highest level in 9 years Medications currently in short supply include Chemotherapy drugs, ADHD drugs and antibiotics Drug shortages are not where a drug is out 100% it is where the current supply exceeds the current need Chemotherapy shortages are the most detrimental as patients are on specific medications with specific dosing and alternates are not easy to find if even possible Chemotherapy in those cases is delayed, or lower doses are given Currently close to 2 dozen chemotherapy drugs and in shortage status Why is it occurring? Multi factorial – a factory in India, Intas Pharmaceuticals , that made about one half of Chemo used in the US, had quality issues and was shut down by the FDA last December, other companies did not step up and fill that void This has forced the FDA to allow for some chemo drugs to be imported from China Information on demand is not easy to get as drug companies often want to keep that private to minimize competition 90% of prescriptions are for generic medications- the goal is to keep prices down- encourage sufficient supplies – ensure the meds are safe and effective in generic format Those 3 goals are difficult to hit all at once the 3 pull at each other. Margin on generic drugs is small as companies had a race to the bottom as they tried to gain market share. Continuing to lower the price to knock out competitor but also shrinking margins Covid, inflation and work force shortages have impacted many generic drug manufacturers No perfect solution Medicare to finally negotiate pricing on medications- good or bad? We are all waiting to see the list of drugs that federal officials will target as they pen negotiations on pricing later this year. The new law, part of the Inflation Reduction Act, allowing for Medicare to negotiate on drug prices goes into effect in September of this year For the past 30 years this negotiation was not allowed by law The first round will focus on 10 drugs that are selected for being the most expensive with high use. The list is not yet decided on but a few expected include Embrel- for arthritis, Xarelto- a blood thinner, Januvia- a diabetes medication The price difference in different companies is ridiculous. An example- Xarelto the blood thinner, in the US a years prescription costs $6,240. While in Canada it cost just above $1,000 Now, don't expect any quick changes, the negotiations are scheduled for 2024 and 2025, with the negotiated price change going into effect Jan 1, 2026, however one drug has been impacted with Insulin having a $35 / month cap for Medicare patients that is now in effect. See omnystudio.com/listener for privacy information.

The Original Southern Remedy | Open Q & A - 2/8/23

Southern Remedy

Play Episode Listen Later Feb 8, 2023 44:00

HOST: Dr. Jimmy Stewart, Professor of Internal Medicine and Pediatrics at the University of Mississippi Medical Center.TOPICS DISCUSSED: Prepping for the physician; Cervical dystonia; EKG tests; Angina symptoms; Geriatric doctor shortage; Primary care physician search; Plavix vs Xarelto; TIA diagnosis after stroke; Fatty Liver disease causes, symptoms & treatment; severe Coronary Artery disease; migraine diagnosis and TMJ correlation to breast size. EMAIL: remedy@mpbonline.orgIf you enjoyed listening to this podcast, please consider making a contribution to MPB: https://donate.mpbfoundation.org/mspb/podcast. Hosted on Acast. See acast.com/privacy for more information.

2535: Vertical Heterophoria, Emotional Eating, Collagen & Cartilage, Antiphospholipid Syndrome, Severe Acne, Reduce Sweating (HouseCall)

The Cabral Concept

Play Episode Listen Later Jan 14, 2023 21:18

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions: Tiffany: Good morning Dr. Cabral. Your information and detox have helped me so much over the past year and I am on a mission to do the best for myself and family that I can. I was diagnosed with vertical heterophoria or BVD several years ago. I get terrible anxiety usually while driving and I had a panic attack while going over an extremely high bridge and now I am very anxious whenever I have to drive over bridges. I am usually a very bold person and would not really consider myself anxious, except in these circumstances. Any advice you could give for dealing with this condition? I could not find this topic covered in the podcasts. I do work in front of a computer for 8-10 hours a day but do try to disconnect as soon as I can each evening. Thanks so much for all your great insight. Natalia: Hi Dr. Cabral, could you do a podcast on emotional eating? Thanks a lot Patrick: Hey doc hope all is well. About 6 months ago I tore some cartilage in my elbow ,it only bothers me now if I over do it at the gym doing certain exercise's then it will bother me for a few days. A lot of the things I read said it won't heal itself because there's not enough blood flow there ,what do you think. I just started taking your collagen powder so I will be done it by the time you read this ,how soon does it usually take to see some results thanks so much Michael: Hello Dr.Cabral, I had DVT about 1 1/2 years ago. Went to a hematologist and was told I had APS ( Antiphospholipid Syndrome) a blood clotting disorder. I was told it falls under autoimmune disease. I was told blood thinners (Xarelto 20 mg)would be long term. My question can I reverse this so I don't have to be on blood thinners the rest of my life. 55 years of age eat very healthy exercise 4 to 5 days a week not over wait. Sincerely Michael Rachel: Hello Mr. Cabral. I listen to your podcast on my morning drive and the wealth of information has helped me and my family so much. I've not quite figured this one out yet. My son at 14 started getting severe acne from what seems like an over production of oil. Nothing worked except for Accutane (I didn't know any better) but a year later, it's starting to come back just not severe. He's now 17. My daughter who is 21 started getting the same kind of acne a year and a half ago and nothing is helping her either. What can be causing this? My heart hurts for them. She's in College and it's affecting every aspect of her life. Could this be hereditary? I have not ran any labs because money is an issue. Anything else I could do to help them that's inexpensive? Thanks Janet: Why do i sweat sooo much? Im on medication to help but still haven't noticed any change. I am on antidepressants and anti anxiety medication which is none to increase my sweating but even when i wasnt on them i sweat alot more than normal. Any natural recommendations to help me please!!!! Thank you and huge fan Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community's questions! - - - Show Notes and Resources: StephenCabral.com/2535 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!

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Beyond Biotech podcast 29: Janssen, Knowledge Gate

Beyond Biotech - the podcast from Labiotech

Play Episode Listen Later Jan 12, 2023 29:40

1:03 Labiotech.eu news2:34 Knowledge Gate10:59 Janssen Scientific AffairsThis week, our guests are Viktoriya Vasilenko, Knowledge Gate co-founder and CEO; and Avery Ince, vice president, medical affairs, cardiovascular & metabolism at Janssen Scientific Affairs.Study confirms benefit of XARELTO (rivaroxaban) for secondary prevention of venous thromboembolism in cancer patientsThe Janssen Pharmaceutical Companies of Johnson & Johnson has revealed observational data from eight years of clinical practice showing that the oral Factor Xa inhibitor XARELTO (rivaroxaban) is associated with comparable effectiveness and safety to the Factor Xa inhibitor apixaban for the treatment of cancer-associated thromboembolism (CAT) in a broad cohort of patients with various cancer types. Patients with CAT are at a higher risk of venous thromboembolism (VTE), which is the second-leading cause of death in people with cancer.Data from the observational study in cancer-associated thrombosis for rivaroxaban (OSCAR) found XARELTO showed non-inferiority for the composite outcome of recurrent VTE or any bleeding resulting in hospitalization for treatment of patients with CAT. Janssen said the study adds to the evidence for XARELTO, with more than 300,000 patients having been evaluated since its initial approval in the U.S. in 2011.VTE occurs when a blood clot forms in a vein, affecting between 300,000 to 600,000 Americans each year, commonly triggered by surgery, cancer, immobilization and hospitalization. VTE is a common cause of morbidity and mortality, and people with cancer are at a higher risk for developing VTE than people without cancer.Cancer is known to increase the risk of VTE, with cancer patients having a four to seven times increased risk of developing VTE. These patients also have a higher risk of recurrent VTE and of bleeding.Previous studies such as SELECT-D and CONKO-11 demonstrated that changing from a low molecular weight heparin (LMWH) to XARELTO was associated with a reduction in risk of recurrent thrombosis and improved patient satisfaction.Knowledge GateKnowledge Gate Group provides a key opinion leader online platform. Based in Copenhagen, Denmark, the company bridges the gap between businesses and life science experts. The artificial intelligence platform connects those looking to innovate with the key opinion leaders who can provide valuable insights. It covers a broad range of therapy area experts in the life sciences, and features automated management of all contractual, compliance and confidentiality requirements.SponsorInterested in sponsoring one or more episodes of the podcast? Learn more here!Leave a review on Apple podcastsReviews are hugely important because they help new people discover this podcast. If you enjoyed listening to this episode, we would love to hear your feedback!Connect with uslabiotech.euSubscribe to our newsletter

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A Voice Over Booth Nearly Becomes a Coffin for a Stroke Survivor

Strokecast

Play Episode Listen Later Dec 16, 2022 84:43

Paul Strikwerda is a voice over artist. You may have heard is voice in commercials and other projects. Now, he is also a stroke survivor. The stroke he suffered in his voice over booth engaged multiple primal fears (except for spiders) and is one of the more terrifying I've heard. I'll save the details for the interview itself. The genesis of this episode is that I wanted an answer to the question, "Is voiceover a good career choice for a stroke survivor contending with disabilities?" I was referred to Paul, by Anne Ganguzza of the VO Boss podcast (another great resource for the VO field), and in this episode Paul and I discuss that question and so much more. If you don't see the audio player below, visit http://Strokecast.com/MSN/VoiceOver to listen to the conversation. Click here for a machine-generated transcript Who is Paul Strikwerda? Paul Strikwerda was born and grew up in the Netherlands. He studied music in college and began a career in radio after graduation. Life eventually took him to the United States and an unexpected series of events led him down the path of a voice over artist. Paul wanted to do more than read scripts for clients. He wanted to help other artists in the VO field. He would go on to write "Making Money In Your PJs: Freelancing for Voice-Overs and Other Solopreneurs"* and expand his blog on NetherVoice. He offers an unvarnished view of what life in the VO field is like and what newcomers need to watch out for. For those who want to grow their skills as voice over artists and voice over business people (you have to be both to succeed) Paul offers coaching programs. As he says on https://www.nethervoice.com/coaching/: It's not enough to be outstanding. You need to stand out. Voice overs are the invisibles of the entertainment industry. Competition is increasing, and clients aren't going to book you if they don't know you exist. You need a plan to put you on the map, so clients can find you, hear you, and hire you. Let me be your visibility coach, and help you attract the jobs you're dreaming of doing. What is the Voice Over field? The Voice Over industry is one most people don't think about, but it is one that we've encountered throughout our lives. Every time we hear a narrator on TV or listen to an audio book or hear a corporate voice mail system or listen to the introduction to this show (Thanks, Tim!) or complete eLearning with a person speaking, or learn about pancakes, we are listening to a voice over artist at work. https://youtu.be/FEelYk8y_O4 The breadth of the field is fascinating. The industry itself is facing some growing pains with technology and the increase in computer generated voices. There are some growing pains there. Technology has also led to a democratization of the field in some respects. Microphones and computers for editing have gotten cheaper and more widely available. Home studios are within reach of more people. Some of the same technology trends that drive podcasts drive voice over work Lots of people toy with the idea of becoming voiceover artists so, especially at the entry level, there is a ton of competition. As Paul explains, though, it takes a lot more to be successful than the ability to speak into a microphone. A voice over artist needs to be a business person. The need to sell their services. The need to audition well. They need to write contracts and collect from clients. They need to have a handle on the assortment of ways they can license their voice. And they still need to act and edit and produce. If you are thinking about a career in voice over, and you're will to do all the stuff that goes along with it, Paul's coaching services might be a good fit How does AFib cause stroke? The heart is made up of four chambers. Blood normally flows from the upper right to the lower right to the lungs to the upper left to the lower left and then on to the rest of the body. Moving it efficiently from one place to the next requires a precise rhythm -- the lub-dub of the human heart beat. When someone has AFib, or atrial fibrillation, it means the rhythm isn't quite right sometimes. Maybe different parts of the heart are out of sync, or part vibrates too fast or the heart rhythm itself fluctuates in an odd way. When this happens, blood doesn't always leave the chamber it's in when it's supposed to. And when blood pools or collects in the heart when it shouldn't, it can start to coagulate. It forms clots. Then when the heart beats one of those clots that formed due to AFib can shoot off to another part of the body. If that clot makes it to the brain and gets stuck in a blood vessel, you have an ischemic stroke. So how do you treat it? Well, first you have to find it. Since it is irregular, that's not always easy. Some people will get a surgically installed monitor that will track their heart rhythm for a couple years. Others (like me) will have to wear a device like a Zio patch for two weeks to look for abnormalities. Bill wearing a Zio patch to check for irregular heart rhythm. If doctors find or strongly suspect AFib affects a patient, they have a few treatment options. Blood thinners, or anticoagulants are one option. These medicals like Eliquis and Xarelto are more aggressive at stopping clots than antiplatelet medication like aspirin or Plavix (Clopidogrel). They require additional blood tests and monitoring and put the patient at greater risk of bleeding because that's exactly what their supposed to do. Paul had an ablation therapy. Doctors either freeze or burn some small amount of heart tissue. This disrupts the way electricity flows through the heart, which helps normalize the heartbeat. It's a fascinating technique and eliminated the problem for Paul. You can read more about the procedure from Johns Hopkins or from the Mayo clinic. Some people, if their unusual rhythm is too slow, may need a surgically implanted pacemaker to keep the heart moving enough blood quickly enough. As more people become aware of AFib and research continues, the future of treatment may change dramatically. In defense of social media A lot of people claim to hate social media. The conversation is even louder in December 2022 with Elon Musk's takeover of Twitter. Hate speech, privacy concerns, online bullying, the growth of influencer culture, and more have all made it fashionable to hate on social media. And there are a lot of problems with it. By allowing folks with fringe and extremist views to connect and validate one another's views, it has likely allowed those views to become more common. I'm not defending that. That same mechanism, though, has allowed people with disabilities to find other like-minded folks. Stroke and other disabling conditions are isolating. Appearances of disabled people in media are still rare. After stroke, many folks leave their jobs, removing another vector for social experience. Friends and family members may pull back from stroke survivors either because the survivor is no longer able to participate in the same activities or because they are uncomfortable around a person with disabilities. Or because the survivor is a living reminder that they could find themselves in the same situation. And disabilities themselves make social connection hard. Aphasia impacts conversation. Mobility challenges make it harder to go someplace to meet someone. Vision or equilibrium challenges may make it unsafe to drive. That's to say nothing of the assortment of cognitive, sensory processing, emotional, and fatigue related challenges a survivor may live with. And then we can look beyond the stroke world to our neuro cousins in the MS and TBI communities, and beyond that into the broader world of people with disability. Despite the billion+ disabled people in the world, it's easy to feel the despair of feeling alone. Social media changes that. Or at least helps with it. People with disabilities are able to connect with one another across the street and around the world. There is power in the shared experience -- of finding someone going through a similar experience. There's power and hope in being able to support each other -- to build on the success of others to drive our own recovery and that of others in the community. To be able to raise a voice and say, "This is my hidden reality!" To be able to see that the way someone else treats us may not be right and to have that reinforced by people all over the country. There's power in giving everyone a literal or metaphorical voice. To demonstrate to the world that we're here and we're not going anywhere. Whether it's on Facebook, Instagram, Tik Tok, IRC, MUDDs, Discord, YouTube, or whatever, we can leverage those platforms to empower us to live our best lives. Or to share a simple message of support. Look for communities that resonate with you in a supportive fashion. Follow hashtags like these to start and try others to build your community: #Stroke #StrokeAwareness #StrokeRecovery #BrainInjury #LifeAfterStroke #Aphasia #Mindset #CripTheVote #Disability Social media allows us to connect and that connection is so important to getting more out of life. BEFAST & AHORA Raising voices in social media isn't just about supporting our own lives; it's about saving others. And you can help save other's lives by sharing the stroke warning signs far and wide. We know time is essential. We also know that over the past 20 years or so there have been tremendous changes in stroke treatment - new ways to save lives and reduce the severity of disability. That, of course, assumes treatment begins as soon as possible. And to make that happen, people need to recognize that a stroke is happening and contact emergency services immediately. So share the stroke warning signs in English and Spanish far and wide -- BE FAST and AHORA. And if you have the warning signs to share in another language, share those, too. June Hawkins writing workshop June Hawkins is a stroke survivor in Canada helps stroke survivors connect (or reconnect) with their creativity through the power of writing. Her program is called, "With a Stroke of my Pen" and with her cofacilitator, writing prompts, and exercises she helps other survivors explore their world in writing. The next cohort starts soon. To learn more, visit http://www.withastrokeofmypen.ca/ Hack of the Week There are two things that Paul found critical to going through recovery and living with disability. The first is to have a dedicated partner who can advocate for you. It's not easy to navigate the healthcare industry with sudden, unexpected brain damage, and a supportive partner makes a huge difference. Finding the right person to be your partner in life, of course, is not always the easiest task. The other element which may be easier to cultivate is to develop a "stubborn positivity." The right action-oriented attitude is what gets us developing the right mindset for recovery. It helps us expect to get better and it drives us to do the work -- the exercises, the metal health care, the repetitions, etc. -- that will ultimately help us drive the neuroplastic change in the brain that empowers recovery. Links Where do we go from here? Check out Paul's blog and website at http://NetherVoice.com Share this episode with someone you know by giving them the link http://Strokecast.com/VoiceOver Check out June's writing course at http://www.withastrokeofmypen.ca/ Don't get best…get better More thoughts from Paul

Eliquis v. Xarelto, Adderall shortage, loan forgiveness, and more!

Pharm5

Play Episode Listen Later Oct 21, 2022 4:11

This week on Pharm5: Eliquis v. Xarelto for AFib Improve M&M by quickly titrating HFrEF treatments National Adderall shortage Novavax ok'd as booster Student loan forgiveness application Connect with us! Listen to our podcast: Pharm5 Follow us on Twitter: @LizHearnPharmD References: Dawwas GK, Cuker A, Barnes GD, Lewis JD, Hennessy S. Apixaban versus rivaroxaban in patients with atrial fibrillation and valvular heart disease. Annals of Internal Medicine. October 2022. doi:10.7326/m22-0318 Strong-HF study in patients admitted for acute heart failure (HF) terminated early for superior efficacy. STRONG-HF study in patients admitted for acute heart failure (HF) terminated early for superior efficacy. https://prn.to/3sbDrMv. Published October 13, 2022. Accessed October 14, 2022. Safety, tolerability, and efficacy of rapid optimization, helped by NT-probnp testing, of heart failure therapies - full text view. Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP testinG, of Heart Failure Therapies - Full Text View - ClinicalTrials.gov. https://bit.ly/3MQktVd. Accessed October 14, 2022. Brooks M. FDA confirms nationwide Adderall shortage. Medscape. https://wb.md/3DfXS0O. Published October 14, 2022. Accessed October 14, 2022. FDA drug shortages. FDA. https://bit.ly/3yZiAzG. Accessed October 14, 2022. CDC allows Novavax monovalent COVID-19 boosters for adults ages 18 and older. Centers for Disease Control and Prevention. https://bit.ly/3VM10J9. Published October 19, 2022. Accessed October 20, 2022. Center for Biologics Evaluation and Research. Novavax COVID-19 vaccine. U.S. Food and Drug Administration. https://bit.ly/3eMcbkC. Accessed October 20, 2022. Federal Student Aid. https://bit.ly/3ToNLwC. Accessed October 20, 2022. Duster C. How to qualify for Biden's new student loan forgiveness plan. CNN Politics. https://cnn.it/3ALjKjF. Published Wednesday August 24, 2022. Accessed August 24, 2022. Occupational Employment and Wages, May 2021 - Pharmacists. U.S. Bureau of Labor Statistics. https://bit.ly/3PObHXm. Published March 31, 2022. Accessed August 24, 2022. Smoot C. What is the average pharmacy school debt in 2022? SuperMoney. https://bit.ly/3PHqZNK. Published April 26, 2022. Accessed August 24, 2022.

Eliquis Wins in New Afib Study

MediBlurb's accurate and transparent health Information.

Play Episode Listen Later Oct 19, 2022 1:45

Apixaban (Eliquis) and rivaroxaban (Xarelto) are commonly used in patients with atrial fibrillation and valvular heart disease, but comparative data is limited. New study compares the risks of stroke, systemic embolism and bleeding events.

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Hypnotic Gummies: An Approach to Cannabis Toxicity

PICU Doc On Call

Play Episode Listen Later Oct 2, 2022 17:00

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Welcome to our Episode a three-year-old girl with altered mental status and acute respiratory failure Here's the case presented by Rahul— A three-year-old presents to the PICU with altered mental status and difficulty breathing. Per the mother, the patient was in the usual state of health on the day prior to admission when the mother left her in the care of her maternal grandmother. When mom arrived home later in the afternoon, mom was unable to wake her and reported that she seemed "stiff". She did not have any abnormal movements or shaking episodes. Mom called 911 and the patient was brought to our ED. No known head trauma, though the patient is in the care of MGM throughout the day. No emesis. Nhttp://emesis.no/ (o) recent sick symptoms. No witnessed ingestion, however, the patient's mother reports that MGM is on multiple medications (Xarelto, zolpidem, Buspar, gabapentin, and acetaminophen) and uses THC-containing products specifically THC gummies. In the ED: The patient had waxing and waning mentation with decreased respiratory effort. GCS was recorded at 7. Arterial blood gas was performed showing an initial pH of 7.26/61/31/0. The patient was intubated for airway protection in the setting of likely ingestion. The patient has no allergies, immunizations are UTD. BP 112/52 (67) | Pulse 106 | Temp 36.2 °C (Tympanic) | Resp (!) 14 | Ht 68.5 cm | Wt 14.2 kg | SpO2 100% | BMI 30.26 kg/m² Physical exam was unremarkable-pupils were 4-5mm and sluggish. There was no rash, no e/o of trauma Initial CMP was normal with AG of 12, CBC was unremarkable, and Respiratory viral panel was negative. Serum toxicology was negative for acetaminophen, salicylates, and alcohol. Basic Urine drug screen was positive for THC To summarize key elements from this case, this patient has: Altered mental status: - waxing and waning with GCS less than 8 suggestive of decreased ventilatory effort pre-intubation impending acute respiratory failure Dilated but reactive pupils All of which brings up a concern for possible ingestion such as THC (but cannot rule out other ingestion) This episode will be organized… Pharmacology of Cannabis Clinical presentation of Cannabis toxicity Workup & management of Cannabis toxicity The Cannabis sativa plant contains over 500 chemical components called cannabinoids, which exert their psychoactive effect on specific receptors in the central nervous system and immune system. The 2 best-described cannabinoids are THC and cannabidiol (CBD)—and are the most commonly used for medical purposes. Patients with intractable epilepsy or chronic cancer pain may be using these drugs. THC is the active ingredient of the cannabis plant that is responsible for most symptoms of central nervous system intoxication. The term cannabis and the common name, marijuana, are often used interchangeably). Rahul, can you shed some light on the pharmacokinetics/pharmacodynamics of cannabis? Cannabis exists in various forms: marijuana (dried, crushed flower heads, and leaves), hashish (resin), and hash oil (concentrated resin extract), which can be smoked, inhaled, or ingested. THC is the active ingredient of the cannabis plant that is responsible for most symptoms of central nervous system intoxication, in contrast to CBD, the main non-psychoactive component of cannabis. The potency of cannabis is usually based on the THC content of the preparation. The THC is lipid soluble and highly protein bound and has a volume of distribution of 2.5 to 3.5...

Extended anticoagulation in patients with VTE: The importance of patient preference

Vascular Adviser Podcast

Play Episode Listen Later Jun 15, 2022 19:18

In this episode, Professor Jan Beyer-Westendorf and Professor Rupert Bauersachs discuss the latest real-world evidence for the extended treatment of patients with venous thromboembolism (VTE). They focus on data published from the all-comer Dresden NOAC Registry, which provides important insights on the adherence patterns of patients with VTE on anticoagulation treatment beyond 12 months. Our experts also discuss the FIRST and SWIVTER registries, and how their findings highlight the importance of patient preference in maintaining patient persistence with extended treatment in order for patients to gain the full benefits of their treatment. The views and opinions expressed throughout this podcast are those of the speakers based on their expertise and do not necessarily reflect those of Bayer. • You can read the most up to date CHEST guidelines here: https://journal.chestnet.org/article/S0012-3692(21)01507-5/fulltext • The Dresden NOAC Registry showed high persistence of patients with VTE on rivaroxaban, these results can be viewed here: https://www.thrombosisresearch.com/article/S0049-3848(21)00515-6/fulltext • EINSTEIN CHOICE investigated the extended treatment of VTE patients with rivaroxaban versus aspirin, results from the trial can be found here: https://www.nejm.org/doi/full/10.1056/nejmoa1700518 • The FIRST registry is the largest real-world evidence registry for rivaroxaban to date, read about its findings on treatment adherence here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8606029/ • Read more about the insights from the SWIVTER registry here: https://www.thiemeconnect.com/products/ejournals/abstract/10.1160/TH16-03-0209 • The EINSTEIN EXTENSION study our experts discuss in this podcast can be found here: https://www.nejm.org/doi/full/10.1056/nejmoa1007903 Extended treatment VTE podcast-draft1 4 • The pooled results from the EINSTEIN PE and EINSTEIN DVT studies are available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850944/ • For anticoagulant dosing information, see the European labels for apixaban (Eliquis) (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_- _Product_Information/human/002148/WC500107728.pdf), dabigatran (Pradaxa) (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_- _Product_Information/human/000829/WC500041059.pdf), edoxaban (Lixiana) (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_- _Product_Information/human/002629/WC500189045.pdf), rivaroxaban (Xarelto) (https://www.ema.europa.eu/documents/product-information/xarelto-epar-productinformation_en.pdf) and warfarin (https://www.medicines.org.uk/emc/product/3064/smpc) Recording approval: PP-XAR-ALL-2638-1 Shownotes approval: PP-XAR-ALL-2639-1

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Podcast 789: DOAC

Play Episode Listen Later Jun 13, 2022 3:07 Very Popular

Contributor: Aaron Lessen, MD Educational Pearls: Direct Oral Anticoagulants (DOACs) have surpassed Warfarin and Lovenox® for anticoagulation as they do not require injection and allow for easier discharge. In the ED, they are commonly prescribed after PE or DVT diagnosis. Common DOACs are Apixaban (Eliquis®) and Rivaroxaban (Xarelto®). There has not been a direct head to head study comparing outcomes. 2 large observational studies evaluated the recurrence of clots and bleeding risk in patients with newly prescribed Eliquis® or Xarelto® for DVT or PE. Both studies found that Eliquis® had superior outcomes. Further data is required to determine the preferred DOAC. A randomized trial comparing the two DOACs is upcoming with enrollment ending in 2023. References Dawwas GK, Leonard CE, Lewis JD, Cuker A. Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of Real-World Data. Ann Intern Med. 2022;175(1):20-28. doi:10.7326/M21-0717 Aryal MR, Gosain R, Donato A, et al. Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world. Blood Adv. 2019;3(15):2381-2387. doi:10.1182/bloodadvances.2019000572 Image from: Bristol-Myers Squibb Company. Eliquis 10 Million Patients and Counting. Sec.gov. https://www.sec.gov/Archives/edgar/data/14272/000114036119003478/s002621x16_425.htm. Accessed June 12, 2022. Summarized by Kirsten Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!

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Las noticias más relevantes de negocios 18 de febrero 2022

Ideas de Negocios

Play Episode Listen Later Feb 21, 2022 28:29

ViX es la plataforma de TelevisaUnivisión para competir con Netflix - Nestlé presenta informe de resultados anuales 2021 -Crecimiento de México lo amenazan Covid, inflación, tasas de interés e interrupciones al suministro: Coface -Da Uber las ciudades mejor calificadas en México -La Cajita Feliz de McDonald's otorgará juguetes 100% sustentables -Aeroméxico relanzará conexión con Londres en abril -Schenider Electric informa una inversión de 100 mdd para ampliar la capacidad de producción y logística para Canadá, México y EUA -Plantean castigar con cárcel la publicación de ofertas de trabajo falsas -Genera atractivo nuev establecimiento chino en CDMX -Cofepris alerta sobre falsificación y adulteración de medicamento Xarelto (rivaroxabán) -DTEN anuncia inversión estratégica de zoom -Más del 50% de los Programas Sociales son vulnerables ante la Corrupción: ITAC y GESOC -Presidente de Sony habla sobre los retos, productos y la importancia de México con Luis G y G Noticias internacionales: -Volkswagen en conversaciones con Huawei sobre unidad de conducción autónoma -Resumen de mercados con Marisol Huerta, del Banco Ve por Más.

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DAGÁLL LÆKNANEMANS // Davíð O. Arnar og Páll Torfi Önundarson: Blóðþynning

Landspítali hlaðvarp

Play Episode Listen Later Nov 22, 2021 53:43

"Dagáll læknanemans" er hlaðvarp fyrir læknanema og annað áhugasamt fólk um hvaðeina sem viðkemur klínik og læknisfræði. Stjórnendur eru Sólveig Bjarnadóttir og Teitur Ari Theodórsson. Í þessum þætti er fjallað um blóðþynningu og viðmælendur eru Davíð O. Arnar sérfræðingur í hjartalyflækningum og Páll Torfi Önundarson sérfræðingur í blóðlækningum. Ræddir eru kostir og gallar blóðþynningar með nýju lyfjunum (DOAC) í samanburði við warfarín bæði með tilliti til virkni og aukaverkana. Þá deila viðmælendur þáttarins sinni framtíðarsýn og hvort nýju lyfin munu algerlega taka yfir eða hvort að warfarín muni áfram gegna mikilvægu hlutverki í blóðþynningarmeðferð sjúklinga.Þessi þáttur er annar í röðinni af þremur sem unnir eru í samstarfi við læknadeild. Munu þeir nýtast í kennslu í lyfjafræði á 3. ári við Háskóla Íslands. Magnús Karl Magnússon, prófessor í lyfjafræði og sérfræðingur í blóðlækningum, heldur utan um verkefnið og er jafnframt viðmælandi í þáttunum þremur.Dagáll læknanemans er sjálfstæð þáttasyrpa innan Hlaðvarps Landspítala. Þættirnir eru aðgengilegir á helstu samfélagsmiðlum Landspítala og einnig í streymisveitunum Spotify og Apple iTunes, ásamt hlaðvarpsveitum á borð við Simplecast, Pocket Casts og Podcast Addict.(Tónlist: "Garden Party" með Mezzoforte. Notað með leyfi frá hljómsveitinni.)SIMPLECAST:https://landspitalihladvarp.simplecast.com/episodes/dagall-20

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Lessons from Leadership with Berger Montague, one of Philadelphia's Top Trial Law Firms

Mass Tort News LegalCast

Play Episode Listen Later Oct 26, 2021 36:04

On today's episode of Mass Tort News LegalCast, I sat down with Dena Young and John Albanese of the law firm of Berger Montague. Dena is Senior Counsel in the firm's Philadelphia office with significant experience in the mass tort space, involving dangerous and defective medical devices, pharmaceutical, and consumer products including Talcum Powder, Transvaginal Mesh, Roundup, Risperdal, Viagra, Zofran, and Xarelto. She discusses her work on the Allergan BIOCELL textured breast implant products liability litigation, and explains how she recognized an opportunity to help victims when other lawyers shied away from doing so. For Dena, her work is a passion project that allows her to connect on a very personal level with her clients. John is an associate in the firm's Minneapolis office. Like Dena he got his start with mass torts at an early stage in his career. John talks with me about the positive work culture at Berger Montague, where every single team member's voice matters. John is fueled by his passion for the practice of law and his desire to help his clients seek justice. As always, please remember to subscribe and follow us on social media. Enjoy the show. LinkedIn: https://www.linkedin.com/company/mass-tort-news Twitter: https://www.twitter.com/masstortnewsorg Facebook: https://www.facebook.com/masstortnews.org

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Factor Xa Inhibitor Antidote - pt 2 (Xarelto/Eliquis)

factor antidote inhibitor eliquis xarelto

Play Episode Listen Later Sep 1, 2021 12:38

Episode NotesFor more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: ·PrevMed's website·PrevMed's YouTube channel·PrevMed's Facebook page

Factor Xa Inhibitor Antidote - pt 1 (Xarelto/Eliquis)

factor antidote inhibitor eliquis xarelto

Play Episode Listen Later Aug 28, 2021 6:57

For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: ·PrevMed's website·PrevMed's YouTube channel·PrevMed's Facebook page

HEALTH/BEAUTY

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Play Episode Listen Later Aug 4, 2021 0:48

SAVE UP TO 80% ON YOUR MEDICATION. Eliquis, Xarelto, Viagra, Cialis and more. Licensed and Certified. Lowest Price Guaranteed. Call 855-899-6256 and get free shipping on your first order. (Open M-F). AS8/5 ATTENTION OXYGEN THERAPY USERS! Inogen One G4 is capable of full 24/7 oxygen delivery. Only 2.8 pounds.FREE information kit. Call 844-322-9935. AS8/5Article Link

HEALTH/BEAUTY

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Play Episode Listen Later Jun 23, 2021 1:05

SAVE UP TO 80% on your medication Eliquis, Xarelto, Viagra, Cialis and more. Licensed and Certified. Lowest Price Guaranteed. Call 855-899-6256 and get free shipping on your first order. (Open M-F). AS6/24 ATTENTION DIABETICS! Save money on your diabetic supplies! Convenient home shipping for monitors, test strips, insulin pumps, catheters and more! To learn more call now1-855-504-9031. AS6/24 ATTENTION OXYGEN THERAPY USERS! Inogen One G4 is capable of full 24/7 oxygen delivery. Only 2.8 pounds. FREE information kit. Call 844-322-9935. AS6/24Article Link

Anticoagulantes: Marevan ou Xarelto?

Doutor TV Podcasts

Play Episode Listen Later Jun 16, 2021 12:14

A jornalista Keila Lima conversou com o hematologista Dr. Pedro Hsieh sobre anticoagulantes. PRODUÇÃO DOUTOR TV Site: www.doutortv.com.br E-mail: contato@doutortv.com.br MAIS INFORMAÇÕES Dr. Pedro Hsieh Site: www.transduson.com.br

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HEALTH/BEAUTY

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Play Episode Listen Later Jun 16, 2021 1:06

ATTENTION DIABETICS! Save money on your diabetic supplies! Convenient home shipping for monitors, test strips, insulin pumps, catheters and more! To learn more call now 1-855-504- 9031. AS6/17 ATTENTION OXYGEN THERAPY USERS! Inogen One G4 is capable of full 24/7 oxygen delivery. Only 2.8 pounds. FREE information kit. Call 844-322-9935. AS6/17 SAVE UP TO 80% ON YOUR MEDICATION. Eliquis, Xarelto, Viagra, Cialis and more. Licensed and Certified. Lowest Price Guaranteed. Call 855-899-6256 and get free shipping on your first order. (Open M-F). AS6/17Article Link

HEALTH/BEAUTY

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Play Episode Listen Later Jun 9, 2021 0:48

ATTENTION DIABETICS! Save money on your diabetic supplies! Convenient home shipping for monitors, test strips, insulin pumps, catheters and more! To learn more call now 1-855-504- 9031. AS6/10 SAVE UP TO 80% ON YOUR MEDICATION. Eliquis, Xarelto, Viagra, Cialis and more. Licensed and Certified. Lowest Price Guaranteed. Call 855-899-6256 and get free shipping on your first order. (Open M-F). AS6/10Article Link

HEALTH/BEAUTY

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Play Episode Listen Later May 27, 2021 1:07

SAVE UP TO 80% ON YOUR MEDICATION. Eliquis, Xarelto, Viagra, Cialis and more. Licensed and Certified. Lowest Price Guaranteed. Call 855-899-6256 and get free shipping on your first order. (Open M-F). AS5/27 OXYGEN - ANYTIME. Anywhere. No tanks to refill. No deliveries. The All- New Inogen One G4 is only 2.8 pounds! FAA approved! FREE info kit: 1-844-322-9935. AS5/27 ATTENTION DIABETICS! Save money on your diabetic supplies! Convenient home shipping for monitors, test strips, insulin pumps, catheters and more! To learn more call now 1- 855-504-9031. AS5/27Article Link

HEALTH/BEAUTY

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Play Episode Listen Later May 19, 2021 1:06

SAVE UP TO 80% ON your medication. Eliquis, Xarelto, Viagra, Cialis and more. Licensed and Certified. Lowest Price Guaranteed. Call 855-899-6256 and get free shipping on your first order. (Open M-F). AS5/20 ATTENTION DIABETICS! Save money on your diabetic supplies! Convenient home shipping for monitors, test strips, insulin pumps, catheters and more! To learn more call now 1-855-504-9031. AS5/20 OXYGEN - ANYTIME. Anywhere. No tanks to refill. No deliveries. The All-New Inogen One G4 is only 2.8 pounds! FAA approved! FREE info kit: 1-844-322-9935. AS5/20Article Link

HEALTH/BEAUTY

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Play Episode Listen Later May 19, 2021 1:06

SAVE UP TO 80% ON your medication. Eliquis, Xarelto, Viagra, Cialis and more. Licensed and Certified. Lowest Price Guaranteed. Call 855-899-6256 and get free shipping on your first order. (Open M-F). AS5/20 ATTENTION DIABETICS! Save money on your diabetic supplies! Convenient home shipping for monitors, test strips, insulin pumps, catheters and more! To learn more call now 1-855-504-9031. AS5/20 OXYGEN - ANYTIME. Anywhere. No tanks to refill. No deliveries. The All-New Inogen One G4 is only 2.8 pounds! FAA approved! FREE info kit: 1-844-322-9935. AS5/20Article Link

Policosanol: What Is It? Does It Work? Should I Trade My Statins, Xarelto or Aspirin for This?

Play Episode Listen Later Mar 8, 2021 7:33

Policosanols are plant waxes and given for cholesterol or LDL problems. The logic for the mechanism is similar to phytosterols. Phytosterols are the plant version of cholesterol but maybe more healthy. Policosanols are the plant version of fatty acids. They are for the most part safe. The major reaction concern may be increased bleeding. This is a concern since most people with CV inflammation or LDL problems are also taking baby aspirin or a blood thinner.For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: PrevMed's blogPrevMed's websitePrevMed's YouTube channelPrevMed's Facebook page

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The Gary Null Show - Why Should We Trust a Vaccine from a Condom Maker?

The Gary Null Show

Play Episode Listen Later Mar 5, 2021 61:38

Why Should We Trust a Vaccine from a Condom Maker? Richard Gale and Gary Null PhD Progressive Radio Network, March 5, 2021 For decades, according to a Guardian article, “consumers worldwide have named the $347 billion pharmaceutical behemoth Johnson and Johnson (J&J) as one of its most trusted brands.” From its humble beginnings in the 1880s, making cotton gauze dressings and eventually band aids, baby powder and shampoo, J&J has expanded into one of the most powerful multinational pharmaceutical and medical device companies in the world. In 1959, it entered the world of Big Pharma as a leading player after succeeding in getting Tylenol approved as an over-the-counter drug. Shortly thereafter J&J commenced with a flurry of acquisitions to increase its product line, which included Neutrogena, Cordis, DePuy, Janssen Pharmaceutica and Centocor. Today, in most American home medicine cabinets one will find a popular J&J product: Listerine, Tylenol and Benadryl, Neutrogena skin cream, Rogaine, Neosporin antibacterial ointment, or Destin to treat diaper rashes. Now, people are eager for J&J’s “one shot and you’re done” Covid-19 vaccine despite health officials’ fears it may be less effective than Moderna’s and Pfizer’s mRNA competitors. Nevertheless, vaccination centers and pharmacies are racing to get their hands on the new adenovirus-based vaccine. And as we will further note below, this is from a company that has absolutely no past experience in vaccine development and manufacturing. However, we need to seriously challenge J&J’s reputation. A 2019 report by the British intelligence firm Alva has noted that J&J’s reputation has sunk dramatically during the past years, from 9th place among 58 major pharmaceutical firms to 57th. Certainly, this is not a company with a clean ethical record. A review of J&J’s rap sheet over the past three decades presents a dire and contrary image that should lead us to question the company’s claims about its Covid-19 vaccine given the lucrative market the pandemic has created for the most aggressive medical corporations. Similar to its equally over-sized competitors Glaxo, Merck and Pfizer, J&J too has had to pay out billions of dollars over the decades for civil settlements and criminal activities. As the pharmaceutical giant receives applause across the mainstream media for the release and FDA emergency approval for its Covid-19 vaccine, Brazil’s Public Prosecution Service started an investigation into J&J’s antitrust activities under the Foreign Corrupt Practices Act (FCPA) for “possible improper payments in its medical device industry.” This was part of an FBI bribery scheme investigation that included Seimens, General Electric and Philips acting as a larger cartel to illegally payoff government officials in return for securing contracts with Brail’s national health programs. The charges also include price gouging, inflating prices up to 800 percent the market price to cover bribes. This is not the first time J&J has violated FCPA laws. In 2011, J&J was charged by the Department of Justice with conspiracy for paying off Greek doctors to advance its product sales. The SEC also charged civil complaints. The company had to pay out a $70 million penalty for buying off officials in Greece, Poland and Romania. In 2010, an executive for J&J’s subsidiary DePuy was sentenced to a year in prison for corrupt payments to physicians within the Greek national healthcare system. As one of the world’s leading medical device companies, J&J has had its share of recalls for faulty products including contact lenses and hip implants In 2013, it paid nearly $2.5 billion to compensate 8,000 recipients for its flawed hip implants Again in 2016, another $1 billion was awarded to plaintiffs injured from this device. One particular dubious activity the company became involved with in 2008 was to launch a “phantom recall.” When its Motrin IB caplets were discovered to not properly dissolve, it hired outside contractors to buy up store supplies in order to avoid making public declaration. No one would have known of this activity and it would have gotten past the eyes of FDA inspectors had the deception not been exposed during a Congressional investigation. Other major J&J lawsuits and recalls for faulty products include: 1995 - $7.5 million fine for destroying documents to cover up an investigation into wrongful marketing of its Retin-A acne cream to remove wrinkles 1996 – An undisclosed settlement on false claims over condom protection claims to protect against HIV and other STDs. 2000 – J&J’s subsidiary LifeScan was found guilty for selling defective blood glucose monitors and failed to inform the FDA. All total, $105 million was paid out. 2001 – Paid out $860 million in a class action lawsuit for misleading customers about prematurely discarding its 1-Day Acuvue soft contact lens. J&J recommended they should only be worn once although it was discovered the lenses were no different than the regular Acuvue lens that would last for two weeks 2010 - $81 million settlement for misbranding its anti-epileptic drug Topamax to treat psychiatric disorders and hiring outside physicians to join its sales force to promote the drug for unapproved conditions. The following year, J&J paid $85 million for similar charges against its heart drug Natrecor 2011 – Several of its baby products were discovered to contain carcinogenic ingredients 2013 – The US Justice Department charged the company $2.2 billion in criminal fines for marking its autism and anti-psychotic drug Risperdal for unapproved uses. Forty-five states had filed civil lawsuits against J&J in the scandal Risperdal is horrendous drug that contributes to rapid weight gain and a condition known as gynescomastia, irregular enlarged breasts in men. Semmelweis reports that J&J’s subsidiary Janssen also had an aggressive campaign to market its use in children with behavioral challenges. Other serious adverse effects from Risperdal reported by the FDA include diabetes mellitus, hyperprolactinaemia, somnolence, depression, anxiety, psychotic behavior, suicide and death. The company’s legal problems over Risperdal do not appear to have ended. In October 2019, a Philadelphia jury awarded a man $8 billion in punitive damages for failing to warn that the drug could cause young men to grow breasts. Other recent suits include litigation over its blood thinner Xarelto risks of internal bleeding, and a $775 million settlement to 25,000 plaintiffs. 2016 - Two women were awarded $127 million in damages for the talc in its J&J Baby Powder causing ovarian cancer. Later, over 1,000 similar cases came forward. During the trial it was discovered that J&J suspected a link between talcum and ovarian cancer back in the 1970s. A Missouri verdict fined the company over $4 billion but it was later reduced to $2.1 billion. A New York Times investigation into internal J&J memos uncovered evidence that the talcum powder may have contained asbestos. These cases continue. In July 2019, J&J made efforts to dismiss 14,000 lawsuits over the talcum-cancer risk. More recently, J&J has been in the spotlight for its role in contributing to the deadly opioid crisis. The company holds the patent for a unique strain of opium poppy commonly named Norman. It is the leading provider of the opioid for Purdue Pharma’s painkiller OxyContin. An Oklahoma court ordered a $465 million fine. This opened the door for other states to follow suit. To fully realize how insane the system is, the half a billion dollar civil fine was good news on Wall Street, which anticipated the verdict would be in the billions of dollars. Consequently, J&J’s stock rose 2 percent after the judge’s ruling. And despite J&J being Purdue’s major supplier, and a major contributor in the US’s opioid epidemic, the latter was forced to file for bankruptcy due to mounting lawsuits for overdose deaths. Finally, we might ask why a 140 year old company, with no history whatsoever in vaccine development, has now become among the heroes in the immunological war against Covid-19? J&J is not a household name in the vaccine industry. It is utterly absent, let alone ranks among the world’s 20 major vaccine makers. Among the 53 vaccines for other infections approved and licensed by the CDC, not one is manufactured by the nation’s leader in mouthwash and baby powder. It is therefore no surprise that the company had to partner with Merck to manufacture its Covid vaccine to meet demand. It has no history or expertise in this medical field. However, the Covid pandemic is a cash cow for the drug industry’s taking. Bernstein market analyst Ronny Gal predicts Covid-19 vaccine sales will reach $40 billion this year. A more realistic figure is likely higher since together Moderna and Pfizer project their revenues at $32 billion. Then there are the other major vaccines by AstraZeneca, J&J and Novavax entering the competition. According to the London School of Hygiene and Tropical Medicine’s vaccine research tracker, over 200 vaccines against Covid-19 are in development worldwide. It is an enormous pumpkin pie and everyone in the medical universe wants a slice from it. So why shouldn’t we expect a non-vaccine player such as J&J to be eager to leap into the frenzy? Finally, there is a disturbing question that we have no certain answer for. How is it that a drug and household health product company, with no prior history in vaccine development, can develop and rush to market its first vaccine against a viral strain that was only identified 14 months ago? Developing a vaccine requires many years and necessitates the establishment of an R&D infrastructure vastly different than conventional drug development. The other major companies developing Covid-19 vaccines have been in the business for decades. But not J&J. There is something more to this story that demands investigation. And if the company’s long rap sheet offers any warning, it is that we must be wary of any claims J&J publicly states about the efficacy and safety of its products. Especially when the pandemic promise to increase the profits of numerous shareholders.

How to Avoid a Wheelchair - Stroke & Atrial Fib

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Play Episode Listen Later Feb 14, 2021 18:51

Strokes are the #1 cause of significant long-term disability, the #5 (or #3) cause of death. 55,000 more women have strokes each year. It's decreasing due to better management of blood pressure - the biggest risk factor.But the new challenge in stroke prevention is atrial fibrillation. Paroxysmal (occasional, undiagnosed) atrial fib is becoming recognized as one of the new leading causes of stroke. So, it is becoming far more important to look for atrial fib.Now, it has become clear that there are better ways to prevent a stroke if medication is needed. Aspirin does help. But Plavix is better. Warfarin or Coumadin is even better. But Elliquis, Xarelto, dabigatran--the NOACs (new oral antiCoagulants)--are even far more effective at preventing a stroke.For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: PrevMed's article on stroke & atrial fibPrevMed's websitePrevMed's YouTube channelPrevMed's Facebook page

Pharm Bites: Xarelto

Urgent Care Basics

Play Episode Listen Later Dec 24, 2020 3:21

Today we discuss Xarelto Hope you enjoy! Please follow us at urgentcarebasics.com facebook.com/Urgentcarebasics/ instagram.com/urgentcarebasics/ Or email us at urgentcarebasics@gmail.com Also check out the recommend page at urgentcarebasics.com/recommended Have a great day!

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Ep230 - The Side of Effects of Xarelto May Include…

The Denver Degenerates

Play Episode Listen Later Nov 2, 2020 51:43

Hello Degenerates! Well another week in the books. This week we come hot, fresh off a tequila battle. Obviously that means we were on absolute fire. Whether we talked the new Covid normal, or games we played as teenagers where the ultimate goal was to hurt each other, or we made our awful week 8 NFL picks, we did it with poise and passion! Please enjoy! Twtter & Snapchat – Dendegenerates Instagram – The Denver Degenerates Facebook - https://www.facebook.com/thedenverdegenerates/ Email – denverdegenerates@gmail.com Website – denverdegenerates.com Merchandise - https://teespring.com/stores/denverdegenerates If you're looking to Buy or Sell a House hit up Gabe - GabeGRealty.com -Jason

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Dual Pathway Inhibition: A Different Antithrombotic Strategy for Patients With CAD/PAD

Play Episode Listen Later Oct 19, 2020

Host: Jennifer Caudle, DO Guest: Sandeep Nathan, MD Tune in as Dr Sandeep Nathan discusses treatment guidelines for thrombotic risk reduction in patients with chronic CAD/PAD and shares data on these patients from the REACH Registry. Dr Nathan will also explain a different treatment paradigm, dual pathway inhibition, using XARELTO® 2.5 mg twice daily plus low-dose aspirin once daily for the reduction in the risk of major cardiovascular events. This promotional educational activity is brought to you by Janssen Pharmaceuticals, Inc., and is not certified for continuing medical education. The consultant is a paid speaker for Janssen Pharmaceuticals, Inc. The speaker is presenting on behalf of Janssen and must present information in compliance with FDA requirements applicable to Janssen. ©Janssen Pharmaceuticals, Inc. 2020 July 2020 cp-147541v1

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Dual Pathway Inhibition: A Different Antithrombotic Strategy for Patients With CAD/PAD

Play Episode Listen Later Oct 19, 2020

Host: Jennifer Caudle, DO Guest: Sandeep Nathan, MD Tune in as Dr Sandeep Nathan discusses treatment guidelines for thrombotic risk reduction in patients with chronic CAD/PAD and shares data on these patients from the REACH Registry. Dr Nathan will also explain a different treatment paradigm, dual pathway inhibition, using XARELTO® 2.5 mg twice daily plus low-dose aspirin once daily for the reduction in the risk of major cardiovascular events. This promotional educational activity is brought to you by Janssen Pharmaceuticals, Inc., and is not certified for continuing medical education. The consultant is a paid speaker for Janssen Pharmaceuticals, Inc. The speaker is presenting on behalf of Janssen and must present information in compliance with FDA requirements applicable to Janssen. ©Janssen Pharmaceuticals, Inc. 2020 July 2020 cp-147541v1

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Clinical Trial Data Evaluating a Treatment for Deep Vein Thrombosis (DVT) and/or Pulmonary Embolism (PE) in Patients With Active Cancer

Play Episode Listen Later Aug 17, 2020

Host: Jennifer Caudle, DO Guest: Steven Fein, MD Here to delve into venous thromboembolism (VTE) clinical trial data on XARELTO®, a treatment option approved for deep vein thrombosis (DVT) and pulmonary embolism (PE), is Dr Steven Fein. He will highlight the EINSTEIN clinical trials, a subgroup analysis, and the results of a randomized, open-label pilot trial for the treatment of DVT and/or PE in patients with active cancer. This promotional educational activity is brought to you by Janssen Pharmaceuticals, Inc., and is not certified for continuing medical education. The consultant is a paid speaker for Janssen Pharmaceuticals, Inc. The speaker is presenting on behalf of Janssen and must present information in compliance with FDA requirements applicable to Janssen. ©Janssen Pharmaceuticals, Inc. 2020 August 2020 cp-145201v1

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Clinical Trial Data Evaluating a Treatment for Deep Vein Thrombosis (DVT) and/or Pulmonary Embolism (PE) in Patients With Active Cancer

Play Episode Listen Later Aug 17, 2020

Host: Jennifer Caudle, DO Guest: Steven Fein, MD Here to delve into venous thromboembolism (VTE) clinical trial data on XARELTO®, a treatment option approved for deep vein thrombosis (DVT) and pulmonary embolism (PE), is Dr Steven Fein. He will highlight the EINSTEIN clinical trials, a subgroup analysis, and the results of a randomized, open-label pilot trial for the treatment of DVT and/or PE in patients with active cancer. This promotional educational activity is brought to you by Janssen Pharmaceuticals, Inc., and is not certified for continuing medical education. The consultant is a paid speaker for Janssen Pharmaceuticals, Inc. The speaker is presenting on behalf of Janssen and must present information in compliance with FDA requirements applicable to Janssen. ©Janssen Pharmaceuticals, Inc. 2020 August 2020 cp-145201v1

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VTE rate, "COVID toes," and Virchow's triad: What you need to know about COVID and coagulation

Blood & Cancer

Play Episode Listen Later May 21, 2020 32:48

Adam C. Cuker, MD, joins host David H. Henry, MD, to discuss recent findings regarding coagulation in COVID-19 patients. Both Dr. Cuker and Dr. Henry both practice at the Hospital of the University of Pennsylvania in Philadelphia. Dr. Cuker cited data suggesting at least 25%-30% of patients with COVID-19 develop venous thromboembolism (VTE), despite receiving prophylactic anticoagulation. Furthermore, COVID-19 patients have presented with “lots of different thrombotic manifestations,” he said. This includes stroke and “COVID toes syndrome,” a condition in which patients present with ischemic toes, which appears to have a thromboembolic etiology. Dr. Cuker suggested that all three aspects of Virchow’s triad may be at play in patients with COVID-19 who have thrombotic manifestations, including: Circulatory stasis (in patients who are immobilized/sedated/prone/paralyzed). Hypercoagulability (inflammation, high levels of factor VIII and fibrinogen, neutrophil extracellular traps). Endothelial injury (SARS-CoV-2 may infect endothelial cells via ACE2). Dr. Cuker notes that high D-dimer correlates with disease severity and prognosis in COVID-19 patients. He also compares COVID-19 to heparin-induced thrombocytopenia (HIT), noting that both are associated with venous and arterial thromboses. And, like HIT patients, those with COVID-19 may require therapeutic-intensity anticoagulation to prevent clots. Dr. Cuker says his hospital’s recommendations for anticoagulation in COVID-19 patients are as follows: Stable hospitalized patients should receive standard-intensity prophylaxis. ICU patients should receive intermediate- or therapeutic-intensity anticoagulation (at the discretion of the provider). On discharge, patients should receive low-dose rivaroxaban (Xarelto) at 10 mg daily for 30 days as prophylaxis. A nonhospitalized patient who has no risk factors for thrombotic events should not receive thromboprophylaxis. Dr. Cuker also discusses two recent publications on thrombosis and anticoagulation in COVID-19 patients. In one study, thrombotic events occurred in 31% of COVID-19 patients admitted to the ICU at three Dutch hospitals (Thromb Res. 2020 Apr 10. pii: S0049-3848(20)30120-1). Another study suggested that systemic anticoagulation may improve outcomes of patients hospitalized with COVID-19 (J Am Coll Cardiol. 2020 May 5. pii: S0735-1097(20)35218-9). Show notes by Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. Disclosures: Dr. Henry has no financial disclosures relevant to this episode. Dr. Cuker has served as a consultant for Synergy CRO. His institution has received research support on his behalf from Alexion, Bayer, Pfizer, Novo Nordisk, Sanofi, Spark, and Takeda. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

Podcast 555: Anticoagulation vs. Antiplatelet

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Play Episode Listen Later Apr 27, 2020 3:03

Contributor: Don Stader, MD Educational Pearls: When do we give antiplatelet drugs or anti-coagulation drugs? Arterial issues get antiplatelet therapy Venous issues, or slow flow states, get anticoagulation therapy. High flow areas (arteries) are more prone to platelet clotting while the venous system is more prone to allowing blockages caused by coagulation factors. The main side effect with antiplatelet and anticoagulants is bleeding. Typically antiplatelet drugs cause more bleeding issues because platelets are made in the bone marrow, while coagulation factors are made in the liver, so it takes longer for the bone marrow to replete platelets versus the liver which is a fast synthesizer of clotting factors. Reversal of antiplatelet drugs can take a while, so patients on these drugs (ex. Plavix) may need a week of withholding the drug to get surgery, while anti-coagulation drugs (ex. Xarelto) can be stopped a day or two prior to surgery. References 1. Altiok, E. Marx, N. Oral Anticoagulation: Update on Anticoagulation With Vitamin K Antagonists and Non–Vitamin K–Dependent Oral Anticoagulants. Dtsch Arztebl Int. 2018 Nov; 115(46): 776–783. Published online 2018 Nov 16. doi: 10.3238/arztebl.2018.0776 2. Kapil, N. Et al. Antiplatelet and Anticoagulant Therapies for Prevention of Ischemic Stroke. Clin Appl Thromb Hemost. 2017 May;23(4):301-318. doi: 10.1177/1076029616660762. Epub 2016 Jul 26. 3. Ostergaard, L. Fosbol EL. Roe MT. The Role of Antiplatelet Therapy in Primary Prevention. A Review. Curr Pharm Des. 2017;23(9):1294-1306. doi: 10.2174/1381612822666161205115540. Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD

Podcast 552: PE Management and Risk Stratification

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Play Episode Listen Later Mar 30, 2020 9:49

Contributor: Dylan Luyten, MD Educational Pearls: After you diagnose a pulmonary embolism (PE) via CT or VQ scan, we need to categorize the PE as massive, sub-massive, or just PE to dictate treatment. Massive PE: shock with hypotension due to an embolism, and the treatment of choice is thrombolysis with IV tPA with anticoagulation after lysis. Catheter thrombolysis is not used in the hemodynamically unstable patient but can be done after they are stable. Sub-massive: signs of right heart strain/failure but hemodynamically stable. This can be EKG changes, positive biomarkers, or imaging findings. These patients can be treated with IV heparin as there may benefit from catheter directed thrombolysis which has been shown to lead to better functional outcomes. Everything else can be stratified to determine whether inpatient even outpatient treatment is necessary Pulmonary Embolism Severity Index (PESI) or Hestia criteria and can help determine if the patient is better suited for in or outpatient management. Non massive or sub-massive PEs are treated with heparin/Lovenox bridged to Warfarin, a factor Xa inhibitor (ex. Xarelto), or direct oral anticoagulants (DOAC). Editor’s note: intravenous heparin is preferable to other anticoagulants when considering interventional radiology as it can be shut off and/or reversed if necessary prior to procedure References 1. Sista, A. et al. Stratification, Imaging, and Management of Acute Massive and Submassive Pulmonary Embolism. 2017 Jul;284(1):5-24 2. Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005 Oct 15;172(8):1041-6 3. Jimenez, D. et al. Risk stratification of patients with acute symptomatic pulmonary embolism. Intern Emerg Med. 2016 Feb;11(1):11-8. Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD

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ROYAL MEDICAL TREATMENT(11-19-19)

ROYAL MEDICAL RADIO

Play Episode Listen Later Mar 4, 2020 52:40

Nov 19--Daniel Royal, DO, CTP, JD reviews international obituaries of those who died too soon from diseases they shouldn't have had, reports on side-effects of Xarelto and Tylenol, reviews relationship between hearing loss and cognitive function, shares study on IQ and longevity, and discusses association between glyphosates (Round-Up) and colon cancers in young people....Tired of disease management? Want health optimization? Want to know more about Stem Cells, Natural Cancer Treatments, etc.? Listen to "ROYAL MEDICAL RADIO," Tuesdays 1-2 p.m. (PST), on www.AmericaMatters.us or send an email to: droyal@royalmedicalclinic.com.

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DOACs: Jim Horowitz interviews Rachel Rosovsky

PERTcast

Play Episode Listen Later Dec 18, 2019 37:53

Episode 3: James Horowitz interviews Rachel Rosovsky on DOACs. Dr. Rosovsky is the Director of Thrombosis Research in the Division of Hematology at Mass General Hospital. She is also an Assistant Professor at Harvard and a member of the Board of Directors of the PERT Consortium. Dr. Horowitz is the Director of the CCU at NYU Langone Health and the Co-Chair of the Interdisciplinary Resuscitation Committee. He is also an Assistant Professor or Medicine and a member of the Board of Directors of the PERT Consortium. Directly acting oral anticoagulants. FDA approved DOACS: Xarelto (rivaroxaban), Eliquis (apixaban), Savasya (edoxaban), Pradaxa (dabigatran). All DOACs have similar efficacy in terms of VTE occurrence and better safety profile compared compared to Coumadin. MOA: Dabigatran: directthrombin inhibitor. Rest of the DOACs: factor X inhibitors. DOACS usually do not need monitoring. Most common interaction noted with drugs like ketoconazole (CYP3A4). Dosing: Dabigatran and Edoxaban: Overlap with parenteral enoxaparin for 5 to 10 days is needed. Apixaban and Rivoraxaban: Need loading dose. For apixaban it is 10 mg 2 times a day for 7 days followed by 5 mg 2 times a day. Rivaroxaban: 15 mg 2 times a day for 21 days followed by 20 mg once a day. (Xarelto need to be taken with food) Only 55% of the patients with Coumadin remain in therapeutic range. Drug reversal agents for DOACs Dabigatran reversal: Idarucizumab Xarelto and Eliquis reversal: Andexenat Alpha. Factors in deciding candidacy for DOACs: DOACs in patients with Child-Pugh score B/C cirrhosis should not be used. Renal failure with CrCl 120 kg, based on ISTH guidelines. (higher the BMI may have increased risk of bleeding with better efficacy, potentially due to absorption issues-- levels can fluctuate) Drug monitoring for DOACs: No standardized methods. Not routinely done. It should be considered in patients with extremes of weight and patients who have gone gastric/bariatric surgeries, because all DOACs are absorbed get into upper GI tract. Pregnancy and Venous thromboembolism: No DOACs in pregnancy. Enoxaparin is the treatment of choice -1 mg/kg every 12 hours up to week 36 followed by changing them to unfractionated heparin. (subcutaneous calculated dose). Patients who had prior DVTs/PEs and become pregnant may need prophylactic dose of enoxaparin (40 mg subcutaneous once a day) Cancer and VTE: VTE is a second leading cause of death in cancer patients. Drug of choice was enoxaparin over warfarin. Edoxaban Vs Enoxaparin: Edoxaban with less recurrent VTE, but worse bleeding profile (most bleeds in gastric cancer patients) Rivaroxaban Vs Enoxaparin: Rivaroxaban with less recurrent VTE, but worse bleeding profile (most bleeds in gastric cancer) Cancer patients who may not be good candidate: a) GI cancer b) needing many procedures c) liver/renal failure d)brain mets. Provoked vs Unprovoked and extended a/c: Unprovoked PE: Two-year risk of recurrence 25% or higher. Provoked by surgery [mainly orthopedic surgery, pregnancy, long hospital stay]: risk of recurrence 1% at one year, 3% at 5 years. Flying is a weak risk factor to be considered as provoked. Amplify-Ext trial: 70% decrease risk of recurrence with low dose apixaban without an increased risk of bleeding in unprovoked VTE. Einstein Choice trial: 70% decrease risk of recurrence with low dose rivaroxaban without an increased risk of bleeding. 60% of patients had provoked VTE with ongoing risk factors. (i.e. Obese patients, patients who are immobile, and are still immobile). Cancer screening following PE: 5-10% of patients with VTE would be diagnosed with malignancy in next 5 years. Recommendation is to do age appropriate cancer screening. Valves and DOACS: (increase risk of ischemic events) Reference: Rali P, Gangemi A Moores A et al. Direct-Acting Oral Anticoagulants in Critically Ill Patients. Chest. 2019 Sep;156(3):604-618.

Episode 7 - Reyvow, Xarelto, Xofluza, & CAP

The Rx Daily Dose

Play Episode Listen Later Oct 19, 2019 15:17

Here are the links for everything discussed in Episode 5. Approval of Reyvow for migraine headaches Secuado approved for schizophrenia Added indications for Xarelto Xofluza get a new indication - Just in time for flu season Updated guidelines for Community-acquired pneumonia (CAP) Connect with The Rx Daily Dose:Twitter Instagram YouTube Linkedin WebsiteEmail: therxdailydose@gmail.comConnect with Ian Parnigoni PharmD. on social media:Twitter Instagram Linkedin ★ Support this podcast on Patreon ★

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MPR Weekly Dose Podcast Episode 9

MPR Weekly Dose

Play Episode Listen Later Oct 17, 2019 6:09

This week we talk about new treatment approvals for acute migraine, dry eye disease and schizophrenia; a new indication for Xarelto; and the Centers for Disease Control and Prevention issue an interim guidance for physicians regarding electronic cigarette, or vaping, product use-associated lung injury, or 'EVALI'.

Purchasing Drugs From Canada

Pro Pharma Talks

Play Episode Listen Later Aug 14, 2019 33:57

1. Quality of prescription drugs a. Health Canada responsible for efficacy and safety of drugs marketed in Canada b. Health Canada operates under the Food and Drugs Act and regulatory mandate under the Food and Drug Regulations c. Most drugs are not manufactured in Canada d. There is no parity between drugs available without a prescription in US vs. Canada 2. Availability of prescription drugs a. US Rx received in Canadian pharmacy must be approved by a Canadian physician prior to it being filled – cosigning b. Canada Health Act – drugs administered in Canadian hospitals are approved at no cost to patients c. Employers cover many Canadians and their families d. Drug Shortages Canada – i. Website for reporting drug shortages and discontinuations in Canada ii. Drug sellers must report that they cannot meet demand 3. Cost considerations a. Canada i. Most prescription drugs are imported ii. Government places price ceilings on Brand name medications imported into Canada b. Canadian internet pharmacies are suspect c. Bricks and mortar pharmacies are same as US 4. Opportunity Savings a. HIS Markit study – Abilify costs 87% less and Xarelto costs 60% less b. Concerns that manufacturers will increase prices for drugs in US and Canada 5. State Plans a. Florida b. Vermont 6. Trump’s Plan a. States, individual pharmacies, wholesalers can write proposals and submit for federal approval b. Exclusions – biologics, medications created from living organisms c. FDA would work with manufacturers to bring drugs made in foreign factories to the US (e.g., insulin) 7. Arguments Against – PhRMA a. Counterfeit, dangerous medications b. Canada drug market too small c. Canada doesn’t have an unlimited supply of medications ______ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: info@propharmaconsultants.com Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks YouTube: https://www.youtube.com/user/ProPharmaEducation

Episode 31 - Emergency Department Management of Patients Taking Direct Oral Anticoagulant Agents (Pharmacology CME)

EMplify by EB Medicine

Play Episode Listen Later Aug 6, 2019

Show Notes Jeff: Welcome back to EMplify the podcast corollary to EB Medicine’s Emergency medicine Practice. I’m Jeff Nusbaum and I’m back with Nachi Gupta. This month, we are tackling a topic for which the literature continues to rapidly change - we’re talking about the ED management of patients taking direct oral anticoagulants or DOACs, previously called novel oral anticoagulants or NOACs. Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: This month’s article was authored by Dr. Patrick Maher and Dr. Emily Taub of the Icahn School of Medicine at Mount Sinai, and it was peer reviewed by Dr. Dowin Boatright from Yale, Dr. Natalie Kreitzer from the University of Cincinnati, and Dr. Isaac Tawil from the University of New Mexico. Nachi: In their quest to update the last Emergency Medicine Practice issue on this topic which was published in 2013, they reviewed over 200 articles from 2000 to present in addition to 5 systematic reviews in the cochrane database, as well as guidelines from the American Heart Association, European society of cardiology, and the american college of cardiology. Jeff: Thanks to a strong literature base, Dr’s Maher and Taub found good quality evidence regarding safety and efficacy of the DOACs in relation to warfarin and the heparin-based anticoagulants. Nachi: But do note that the literature directly comparing the DOACs is far more limited and mostly of poor quality. Show More v Jeff: Fair enough, we’ll take what we can get. Nachi: Well, I’m sure more of those studies are still coming. Jeff: Agree. Let’s get started with some basics. Not surprisingly, DOACs now account for a similar proportion of office visits for anticoagulant use as warfarin. Nachi: With huge benefits including reduced need for monitoring and a potential for reduced bleeding complications, this certainly isn’t surprising. Jeff: Though those benefits are not without challenges - most notably the lack of an effective reversal agent and the risk of unintentional overdose in patients with altered drug metabolism. Nachi: Like all things in medicine, it’s about balancing and finding an acceptable risk/benefit profile. Jeff: True. Let’s talk pathophysiology for a minute - the control of coagulation in the human body is a balance between hemorrhage and thrombosis, mediated by an extensive number of procoagulant and anticoagulant proteins. Nachi: Before the development of the DOACs, vitamin K antagonists controlled the brunt of the market. As their name suggests, they work by inhibiting the action of vitamin K, and thus reducing the production of clotting factors 2, 7, 9, and 10, and the anticoagulant proteins C and S. Jeff: Unfortunately, these agents have a narrow therapeutic window and many drug-drug interactions, and they require frequent monitoring - making them less desirable to many. Nachi: However, in 2010, the FDA approved the first DOAC, a real game-changer. The DOACs currently on the market work by one of two mechanisms - direct thrombin inhibition or factor Xa inhibition. Jeff: DOACs are currently approved for stroke prevention in nonvalvular afib, treatment of VTE, VTE prophylaxis, and reduction of major cardiovascular events in stable cardiovascular disease. Studies are underway to test their safety and efficacy in arterial and venous thromboembolism, prevention of embolic stroke in afib, ACS, cancer-associated thrombosis, upper extremity DVT, and mesenteric thrombosis. Nachi: Direct thrombin inhibitors like Dabigatran, tradename Pradaxa, was the first FDA approved DOAC. It works by directly inhibiting thrombin, or factor IIa, which is a serine protease that converts soluble fibrinogen into fibrin for clot formation. Jeff: Dabigatran comes in doses of 75 and 150 mg. The dose depends on your renal function, and, with a half-life of 12-15 hours, is taken twice daily. Note the drastically reduced half-life as compared to warfarin, which has a half-life of up to 60 hours. Nachi: The RE-LY trial for afib found that taking 150 mg of Dabigatran BID had a lower rate of stroke and systemic embolism than warfarin with a similar rate of major hemorrhage. Dabigatran also had lower rates of fatal and traumatic intracerebral hemorrhage than warfarin. Jeff: A separate RCT found similar efficacy in treating acute VTE and preventing recurrence compared with warfarin, with reduced rates of hemorrhage! Nachi: Less monitoring, less hemorrhage, similar efficacy, I’m sold!!! Jeff: Slow down, there’s lots of other great agents out there, let’s get through them all first... Nachi: Ok, so next up we have the Factor Xa inhibitors, Rivaroxaban, apixaban, edoxaban, and betrixaban.As the name suggests, these medications work by directly inhibiting the clotting of factor Xa, which works in the clotting cascade to convert prothrombin to thrombin. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment. After taking 15 mg BID for the first 21 days, rivaroxaban is typically dosed at 20 mg daily with adjustments for reduced renal function. Nachi: The Rocket AF trial found that rivaroxaban is noninferior to warfarin for stroke and systemic embolism prevention without a significant difference in risk of major bleeding. Interestingly, GI bleeding may be higher in the rivaroxaban group, though the overall incidence was very low in both groups at about 0.4% of patients per year. Jeff: In the Einstein trial, patients with VTE were randomized to rivaroxaban or standard therapy. In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Continuing therapy beyond the acute period resulted in similar rates of VTE recurrence and bleeding episodes to treatment with aspirin alone. Nachi: Next we have apixaban, tradename Eliquis. Apixaban is approved for afib and the treatment of venous thromboembolism. It’s typically dosed as 10 mg BID for 7 days followed by 5 mg BID with dose reductions for the elderly and those with renal failure. Jeff: In the Aristotle trial, when compared to warfarin, apixaban was superior in preventing stroke and systemic embolism with lower mortality and bleeding. Rates of major hemorrhage-related mortality were also nearly cut in half at 30 days when compared to warfarin. Nachi: For the treatment of venous thromboembolism, the literature shows that apixaban has a similar efficacy to warfarin in preventing recurrence with less bleeding complications. Jeff: Unfortunately, with polypharmacy, there is increased risk of thromboembolic and hemorrhage risks, but this risk is similar to what is seen with warfarin. Nachi: And as compared to low molecular weight heparin, apixaban had higher bleeding rates without reducing venous thromboembolism events when used for thromboprophylaxis. It’s also been studied in acute ACS, with increased bleeding and no decrease in ischemic events. Jeff: Edoxaban is up next, approved by the FDA in 2015 for similar indications as the other Factor Xa inhibitors. It’s recommended that edoxaban be given parenterally for 5-10 days prior to starting oral treatment for VTE, which is actually similar to dabigatran. It has similar levels of VTE recurrence with fewer major bleeding episodes compared to warfarin. It has also been used with similar effects and less major bleeding for stroke prevention in afib. In the setting of cancer related DVTs specifically, as compared to low molecular weight heparin, one RCT showed lower rates of VTE but higher rates of major bleeding when compared to dalteparin. Nachi: Next we have Betrixaban, the latest Factor Xa inhibitor to be approved, back in 2017. Because it’s utility is limited to venous thromboembolism prophylaxis in mostly medically ill inpatients, it’s unlikely to be encountered by emergency physicians very frequently. Jeff: As a one sentence FYI though - note that in recent trials, betrixaban reduced the rate of VTE with equivalent rates of bleeding and reduced the rate of stroke with an increased rate of major and clinically relevant non-major bleeding as compared to enoxaparin. Nachi: Well that was a ton of information and background on the DOACs. Let’s move on to your favorite section - prehospital medicine. Jeff: Not a ton to add here this month. Perhaps, most importantly, prehospital providers should specifically ask about DOAC usage, especially in trauma, given increased rates of complications and potential need for surgery. This can help with destination selection when relevant. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Nachi: Extremely important to identify DOAC use early. Once the patient arrives in the ED, you can begin your focused history and physical. Make sure to get the name, dose, and time of last administration of any DOAC. Pay particular attention to the med list and the presence of CKD which could point to altered DOAC metabolism. Jeff: In terms of the physical and initial work up - let the sites of bleeding or potential sites of bleeding guide your work up. And don’t forget about the rectal exam, which potentially has some added value here - since DOACs increase the risk of GI bleeding. Nachi: Pretty straight forward history and physical, let’s talk diagnostic studies. Jeff: First up is CT. There are no clear cut guidelines here, so Drs. Maher and Taub had to rely on observational studies and expert opinion. Remember, most standard guidelines and tools, like the canadian and nexus criteria, are less accurate in anticoagulated patients, so they shouldn’t be applied. Instead, most studies recommend a low threshold for head imaging, even with minor trauma, in the setting of DOAC use. Nachi: That is so important that it’s worth repeating. Definitely have a low threshold to CT the head for even minor head trauma patients on DOACs. Basically, if you’re on anticoagulation, and you made it to the ED for anything remotely related to your head, you probably win a spin. Jeff: I suspect you are not alone with that stance... There is, however, much more debate about the utility of follow up imaging and admission after a NEGATIVE scan. Nachi: Wait, is that a thing I should routinely be doing? Jeff: Well there’s not great data here, but in one observational study of 1180 patients on either antiplatelet or anticoagulant therapy, a half a percent of them had positive findings 12 hours later, and importantly none required surgical intervention. Nachi: Certainly reassuring. And for those with positive initial imaging, the authors recommend repeat imaging within 4-6 hours in consultation with neurosurgical services or even earlier in cases of unexpected clinical decline. Jeff: Interestingly, though only a small retrospective study of 156 patients, one study found markedly reduced mortality, 4.9% vs 20.8% in those on DOACs vs warfarin with traumatic intracranial hemorrhage. Nachi: Hmm that actually surprises me a bit with the ease of reversibility of warfarin. Jeff: And we’ll get to that in a few minutes. But next we should talk about ultrasound. As always with trauma, guidelines recommend a FAST exam in the setting of blunt abdominal trauma. The only thing to be aware of here is that you should have an increased index of suspicion for bleeding, especially in hidden sites like the retroperitoneum. Nachi: And just as with traumatic head bleeds, a small observational study of those with blunt abdominal trauma found 8% vs 30% mortality for those on DOACs vs warfarin, respectively. Jeff: That is simply shocking! Let’s also talk lab studies. Hemoglobin and platelet counts should be obtained as part of the standard trauma work up. Assessing renal function via creatinine is also important, especially for those on agents which are renally excreted. Nachi: Though you can, in theory, test for plasma DOAC concentrations, such tests are not routinely indicated as levels don’t correspond to bleeding outcomes. DOAC levels may be indicated in certain specific situations, such as while treating life-threatening bleeding, development of venous thromboembolism despite compliance with DOAC therapy, and treating patients at risk for bleeding because of an overdose. Jeff: In terms of those who require surgery while on a DOAC - if urgent or emergent, the DOAC will need to be empirically reversed. For all others, the recommendation is to wait a half life or even multiple half-lives, if possible, in lieu of level testing. Nachi: Coagulation tests are up next. Routine PT and PTT levels do not help assess DOACs, as abnormalities on either test can suggest the presence of a DOAC, but the values should not be interpreted as reliable measures of either therapeutic or supratherapeutic clinical anticoagulant effect. Jeff: Dabigatran may cause prolongation of both the PT and the PTT, but the overall correlation is poor. In addition, FXa inhibitors may elevate PT in a weakly concentration dependent manner, but this may only be helpful if anti-fXa levels are unavailable. Nachi: Which is a perfect segway into our next test - anti-factor Xa level activity. Direct measurements of the anti-Fxa effect demonstrates a strong linear correlation with plasma concentrations of these agents, but the anticoagulant effect does not necessarily follow the same linear fashion. Jeff: Some labs may even have an anti-FXa effect measurement calibrated specifically to the factor 10a inhibitors. Nachi: While measuring thrombin time is not routinely recommended, the result of thrombin time or dilute thrombin time does correlate well with dabigatran concentrations across normal ranges. Jeff: And lastly, we have the Ecarin clotting time. Ecarin is an enzyme that cleaves prothrombin to an active intermediate that can be inhibited by dabigatran in the same way as thrombin. The ECT is useful for measuring dabigatran concentration - it’s not useful for testing for FXa inhibitors. A normal ECT value could be used to exclude the presence of dabigatran. Nachi: So I think that rounds out testing. Let’s move into the treatment section. Jeff: For all agents, regardless of the DOAC, the initial resuscitation follows the standard principles of hemorrhage control and trauma resuscitation. Tourniquet application, direct pressure, endoscopy for GI bleeds, etc... should all be used as needed. And most importantly, for airway bleeding, pericardial bleeding, CNS bleeding, and those with hemodynamic instability or overt bleeding, those with a 2 point drop in their hemoglobin, and those requiring 2 or more units of pRBC - they all should be considered to have serious, life threatening bleeds. This patient population definitely requires reversal agents, which we’re getting to in a minute. Nachi: A type and screen should also be sent with the plan to follow standard transfusion guidelines, with the goal of a hemoglobin level of 7, understanding that in the setting of an active bleed, the hemoglobin level will not truly be representative. Jeff: Interestingly, in the overdose literature that’s out there, bleeding episodes appear to be rare - occurring in just 5% of DOAC overdose cases. Nachi: Finally, onto the section we’ve all been waiting for. Let’s talk specific reversal agents. Praxbind is up first. Jeff: Idarucizumab or Praxbind, is the reversal agent of choice for dabigatran (which is also called pradaxa). According to data from the RE-LY trial, it reverses dabigatran up to the 99th percentile of levels measured in the trial. Nachi: And praxbind should be given in two 2.5 g IV boluses 15 minutes apart to completely reverse the effects of dabigatran. Jeff: As you would expect given this data, guidelines for DOAC reversal recommend it in major life-threatening bleeding events for patients on dabigatran. Nachi: Next up is recombinant coagulation factor Xa (brand name Andexxa), which was approved in 2018 for the FXa inhibitors. This recombinant factor has a decoy receptor for the FXa agents, thus eliminating their anticoagulant effects. Jeff: Recombinant factor Xa is given in either high or low dose infusions. High dose infusions for those on rivaroxaban doses of >10 mg or apixaban doses >5 mg within the last 8 hours and for unknown doses and unknown time of administration. Low dose infusions should be used for those with smaller doses within the last 8 hours or for last doses taken beyond 8 hours. Nachi: In one trial of 352 patients, recombinant factor Xa given as an IV bolus and 2 hour infusion was highly effective at normalizing anti-FXa levels. 82% of the assessed patients at 12 hours achieved hemostasis, but there were also thrombotic events in 10% of the patients at 30 days. Jeff: And reported thrombotic events aren’t the only downside. Though the literature isn’t clear, there may be limited use of recombinant factor Xa outside of the time of the continuous infusion, and even worse, there may be rebound of anti-Fxa levels and anticoagulant effect. And lastly, the cost is SUBSTANTIAL. Nachi: Is there really a cost threshold for stopping life threatening bleeding…? Jeff: Touche, but that means we need to save it for specific times and consider other options out there. Since this has only been around for a year or so, let’s let the literature play out on this too... Nachi: And that perfectly takes us into our next topic, which is nonspecific reversal agents, starting with prothrombin complex concentrate, also called PCC. Jeff: PCC is FDA approved for rapid reversal of vitamin K antagonist-related hemorrhagic events and is now being used off label for DOAC reversal. Nachi: PCC comes in 3 and 4 factor varieties. 3-factor PCC contains factors 2, 9, 10 and trace amounts of factor 7. 4 factor PCC contains factors 2, 9 10, as well as purified factor 7 and proteins C and S. Jeff: Both also contain trace amounts of heparin so can’t be given to someone with a history of HIT. Nachi: PCC works by overwhelming the inhibitor agent by increasing the concentration of upstream clotting factors. It has been shown, in healthy volunteers, to normalize PT abnormalities and bleeding times, and to achieve effective bleeding control in patients on rivaroxaban, apixaban, and edoxaban with major bleeding events. Jeff: In small studies looking at various end points, 4 factor PCC has been shown to be superior to 3 factor PCC. Nachi: Currently it’s given via weight-based dosing, but there is interest in studying a fixed-dose to decrease both time to medication administration and cost of reversal. Jeff: Guidelines currently recommend 4F PCC over 3F PCC, if available, for the management of factor Xa inhibitor induced bleeding, with studies showing an effectiveness of nearly 70%. As a result, 4F PCC has become an agent of choice for rapid reversal of FXa inhibitors during major bleeding events. Nachi: Next we have activated PCC (trade name FEIBA). This is essentially 4Factor PCC with a modified factor 7. Though traditionally saved for bleeding reversal in hemophiliacs, aPCC is now being studied in DOAC induced bleeding. Though early studies are promising, aPCC should not be used over 4factor PCC routinely as of now but may be used if 4Factor PCC is not available. Jeff: Next we have recombinant factor 7a (trade name novoseven). This works by activating factors 9 and 10 resulting in rapid increase in thrombin. Studies have shown that it may reverse the effect of dabigatran, at the expense of increased risk of thrombosis. As such, it should not be used as long as other agents are available. Nachi: Fresh Frozen Plasma is the last agent to discuss in this section. Not a lot to say here - FFP is not recommended for reversal of any of the DOACs. It may be given as a part of of a balanced massive transfusion resuscitation, but otherwise, at this time, there doesn’t seem to be a clear role. Jeff: Let’s move on to adjunct therapies, of which we have 3 to discuss. Nachi: First is activated charcoal. Only weak evidence exists here - but, according to expert recommendations, there may be a role for DOAC ingestions within 2 hours of presentations. Jeff: Perhaps more useful than charcoal is our next adjunct - tranexamic acid or TXA. TXA is a synthetic lysine analogue with antifibrinolytic activity through reversible binding of plasmin. CRASH-2 is the main trial to know here. CRASH-2 demonstrated reduced mortality if given within 3 hours in trauma patients. There is very limited data with respect to TXA and DOACs specifically, so continue to administer TXA as part of your standard trauma protocol without modification if the patient is on a DOAC, as it’s likely helpful based on what data we have. Nachi: Next is vitamin K - there is no data to support routine use of vitamin K in those taking DOACs - save that for those on vitamin K antagonists. Jeff: Also, worth mentioning here is the importance of hematology input in developing hospital-wide protocols for reversal agents, especially if availability of certain agents is limited. Nachi: Let’s talk about some special circumstances and populations as they relate to DOACs. Patients with mechanical heart valves were excluded from the major DOAC trials. And of note, a trial of dabigatran in mechanical valve patients was stopped early because of bleeding and thromboembolic events. As such, the American College of Cardiology state that DOACs are reasonable for afib with native valve disease. Jeff: DOACs should be used with caution for pregnant, breastfeeding, and pediatric patients. A case series of 233 pregnancies that occurred among patients on a DOAC reported high rates of miscarriage. Nachi: Patients with renal impairment are particularly concerning as all DOACs are dependent to some degree on renal elimination. Current guidelines from the Anticoagulation Forum recommend avoiding dabigatran and rivaroxaban for patients with CrCL < 30 and avoiding edoxaban and betrixaban for patients with CrCl < 15. Jeff: A 2017 Cochrane review noted similar efficacy without increased risk of major bleeding when using DOACs in those with egfr > 30 (that’s ckd3b or better) when compared to patients with normal renal function and limited evidence for safety below this estimated GFR. Nachi: Of course, dosing with renal impairment will be different. We won’t go into the details of that here as you will probably discuss this directly with your pharmacist. Jeff: We should mention, however, that reversal of the anticoagulant in the setting of renal impairment for your major bleeding patient is exactly the same as we already outlined. Nachi: Let’s move on to some controversies and cutting-edge topics. The first one is a pretty big topic and that is treatment for ischemic stroke patients taking DOACs. Jeff: Safety and efficacy of tPA or endovascular therapy for patients on DOACs continues to be debated. Current guidelines do not recommend tPA if the last DOAC dose was within the past 48 hours, unless lab testing specific to these agents shows normal results. Nachi: Specifically, the American Heart Association suggests that INR and PTT be normal in all cases. ECT and TT should be tested for dabigatran. And calibrated anti-FXa level testing be normal for FXa inhibitors. Jeff: The AHA registry actually included 251 patients who received tpa while on DOACs, which along with cohort analysis of 26 ROCKET-AF trial patients, suggest the risk of intracranial hemorrhage is similar to patients on warfarin with INR < 1.7 and to patients not on any anticoagulation who received tpa. However, given the retrospective nature of this data, we cannot exclude the possibility of increased risk of adverse events with tpa given to patients on DOACs. Nachi: Endovascular thrombectomy also has not been studied in large numbers for patients on DOACs. Current recommendations are to discuss with your stroke team. IV lysis or endovascular thrombectomy may be considered for select patients on DOACs. Always include the patient and family in shared decision making here. Jeff: There are also some scoring systems for bleeding risk to discuss briefly. The HAS-BLED has been used to determine bleeding risk in afib patients taking warfarin. The ORBIT score was validated in a cohort that included patients on DOACs and is similarly easy to use, and notably does not require INR values. Nachi: There is also the ABC score which has demonstrated slightly better prediction characteristics for bleeding risk, but it requires high-sensitivity troponin, limiting its practical use. Jeff: We won’t say more about the scoring tools here, but would recommend that you head over to MD Calc, where you can find them and use them in your practice. Nachi: Let’s also comment on the practicality of hemodialysis for removal of the DOACs. Multiple small case series have shown successful removal of dabigatran, given its small size and low protein binding. On the other hand, the FXa inhibitors are less amenable to removal in this way because of their higher protein binding. Jeff: Worth mentioning here also - dialysis catheters if placed should be in compressible areas in case bleeding occurs. The role of hemodialysis for overdose may be limited now that the specific reversal agent, praxbind, exists. Nachi: In terms of cutting-edge tests, we have viscoelastic testing like thromboelastography and rotational thromboelastometry. Several studies have examined the utility of viscoelastic testing to detect presence of DOACs with varying results. Prolongation of clotting times here does appear to correlate with concentration, but these tests haven’t emerged as a gold standard yet. Jeff: Also, for cutting edge, we should mention ciraparantag. And if you’ve been listening patiently and just thinking to yourself why can’t there be one reversal agent to reverse everything, this may be the solution. Ciraparantag (or aripazine) is a universal anticoagulant reversal agent that may have a role in all DOACs and heparins. It binds and inactivates all of these agents and it doesn’t appear to have a procoagulant effect. Nachi: Clinical trials for ciraparantag have shown rapid and durable reversal of edoxaban, but further trials and FDA approval are still needed. Jeff: We’ve covered a ton of material so far. As we near the end of this episode, let’s talk disposition. Nachi: First, we have those already on DOACs - I think it goes without saying that any patient who receives pharmacological reversal of coagulopathy for major bleeding needs to be admitted, likely to the ICU. Jeff: Next we have those that we are considering starting a DOAC, for example in someone with newly diagnosed VTE, or patients with an appropriate CHADS-VASC with newly diagnosed non-valvular afib. Nachi: With respect to venous thromboembolism, both dabigatran and edoxaban require a 5 day bridge with heparin, whereas apixaban and rivaroxaban do not. The latter is not only easier on the patient but also offers potential cost savings with low risk of hemorrhagic complications. Jeff: For patients with newly diagnosed DVT / PE, both the American and British Thoracic Society, as well as ACEP, recommend using either the pulmonary embolism severity index, aka PESI, or the simplified PESI or the Hestia criteria to risk stratify patients with PE. The low risk group is potentially appropriate for discharge home on anticoagulation. This strategy reduces hospital days and costs with otherwise similar outcomes - total win all around. Nachi: Definitely a great opportunity for some shared decision making since data here is fairly sparse. This is also a great place to have institutional policies, which could support this practice and also ensure rapid outpatient follow up. Jeff: If you are going to consider ED discharge after starting a DOAC - there isn’t great data supporting one over another. You’ll have to consider patient insurance, cost, dosing schedules, and patient / caregiver preferences. Vitamin K antagonists should also be discussed as there is lots of data to support their safety outcomes, not to mention that they are often far cheaper…. As an interesting aside - I recently diagnosed a DVT/PE in an Amish gentleman who came to the ED by horse - that was some complicated decision making with respect to balancing the potentially prohibitive cost of DOACs with the massive inconvenience of frequently checking INRs after a 5 mile horseback ride into town... Nachi: Nice opportunity for shared decision making… Jeff: Lastly, we have those patients who are higher risk for bleeding. Though I’d personally be quite uneasy in this population, if you are to start a DOAC, consider apixaban or edoxaban, which likely have lower risk of major bleeding. Nachi: So that’s it for the new material for this month’s issue. Certainly, an important topic as the frequency of DOAC use continues to rise given their clear advantages for both patients and providers. However, despite their outpatient ease of use, it definitely complicates our lives in the ED with no easy way to evaluate their anticoagulant effect and costly reversal options. Hopefully all our hospitals have developed or will soon develop guidelines for both managing ongoing bleeding with reversal agents and for collaborative discharges with appropriate follow up resources for those we send home on a DOAC. Jeff: Absolutely. Let’s wrap up with some the highest yield points and clinical pearls Nachi: Dabigatran works by direct thrombin inhibition, whereas rivaroxaban, apixaban, edoxaban, and betrixaban all work by Factor Xa inhibition. Jeff: The DOACs have a much shorter half-life than warfarin. Nachi: Prehospital care providers should ask all patients about their use of anticoagulants. Jeff: Have a low threshold to order a head CT in patients with mild head trauma if they are on DOACs. Nachi: For positive head CT findings or high suspicion of significant injury, order a repeat head CT in 4 to 6 hours and discuss with neurosurgery. Jeff: Have a lower threshold to conduct a FAST exam for blunt abdominal trauma patients on DOACs. Nachi: Assessment of renal function is important with regards to all DOACs. Jeff: While actual plasma concentrations of DOACs can be measured, these do not correspond to bleeding outcomes and should not be ordered routinely. Nachi: The DOACs may cause mild prolongation of PT and PTT. Jeff: Idarucizumab (Praxbind®) is an antibody to dabigatran. For dabigatran reversal, administer two 2.5g IV boluses 15 minutes apart. Reversal is rapid and does not cause prothrombotic effects. Nachi: Recombinant FXa can be used to reverse the FXa inhibitors. This works as a decoy receptor for the FXa agents. Jeff: Vitamin K and FFP are not recommended for reversal of DOACs. Nachi: Consider activated charcoal to remove DOACs ingested within the last two hours in the setting of life-threatening hemorrhages in patient’s on DOACs. Jeff: Hemodialysis can effectively remove dabigatran, but this is not true for the FXa inhibitors. Nachi: 4F-PCC has been shown to be effective in reversing the effects of the FXa inhibitors. This is thought to be due to overwhelming the inhibitor agent by increased concentrations of upstream clotting factors. Jeff: tPA is contraindicated in acute ischemic stroke if a DOAC dose was administered within the last 48 hours, unless certain laboratory testing criteria are met. Nachi: Emergency clinicians should consider initiating DOACs in the ED for patients with new onset nonvalvular atrial fibrillation, DVT, or PE that is in a low-risk group. Jeff: So that wraps up Episode 31! Nachi: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Jeff: And the address for this month’s cme credit is www.ebmedicine.net/E0819, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net with any comments or suggestions. Talk to you next month!

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Podcast # 483: Dual Antiplatelet Therapy in TIA

therapy md dual summarized anticoagulants antiplatelet clopidogrel ahmeds eliquis xarelto pubmed pmid

Play Episode Listen Later Jun 28, 2019 2:32

Contributor: Don Stader, MD Educational Pearls: Antiplatelets include aspirin and clopidogrel, and are generally used for arterial clotting (MI, stroke) Anticoagulants such as coumadin, Xarelto, Eliquis are generally used for venous clotting (DVT/PE) Growing data suggests that dual antiplatelet therapy (aspirin+clopidogrel) is superior to aspirin alone in reducing stroke for diagnosed with TIA References: Kheiri B, Osman M, Abdalla A, Haykal T, Swaid B, Ahmed S, Chahine A, Hassan M, Bachuwa G, Al Qasmi M, Bhatt DL. Clopidogrel and aspirin after ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis of randomized clinical trials. J Thromb Thrombolysis. 2019 Feb;47(2):233-247. doi: 10.1007/s11239-018-1786-z. PubMed PMID: 30511260. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Before The Show #91 - Navigating Mass Torts Litigation

The Knowledge Group Podcasts

Play Episode Listen Later May 8, 2019 4:09

* Use coupon code PODCAST25 for 25% off this webcast * Webcast URL: https://www.theknowledgegroup.org/webcasts/navigating-mass-torts-litigation/ A large number of mass torts filed over the previous year involve drugs including Xarelto, Risperdal, Opioids and Pradaxa. One notable case is the mass tort against pharmaceutical giant Hoffmann La-Roche with over 500 lawsuits claiming that users of the company's acne drug Accutane, developed inflammatory bowel disease. The New Jersey Supreme Court ruled in favor of Hoffmann La-Roche with its dismissal of the mass tort case. The Court said that the plaintiffs failed to prove that Roche failed to provide internal research to the Food and Drug Administration (FDA). Understanding mass tort case verdicts such as this, as well as the upcoming ones, is critical in devising effective litigation strategies. Join a panel of key thought leaders and professionals assembled by The Knowledge Group as they bring the audience to a road beyond the basics of bringing or defending against a mass tort lawsuit and as they delve into the depth-analysis of the current trends and recent court rulings. Speakers will also provide the audience with practical strategies in bringing out the best in these lawsuits in a rapidly evolving legal climate. For anymore information please click on the webcast url at the top of this description.

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LYFT goes public & GRINDR brings down America

Degenerate Business School

Play Episode Listen Later Mar 30, 2019 35:39

In MACROECONOMICS: Quick update on the yield curve, it reverted back from inversion! Good news, I guess?The US Committee on Foreign Investment orders Chinese company Beijing Kunlun to jettison its majority stake in Grindr. Why you may ask? The answer could blow apart tenuous trade talks between the US and China.In BUSINESSES: LYFT enters the public markets, popping to 87$ a share in a frenzy of exuberance before nestling down to $78 at the bell, but still up near 9% on the day. What did we learn from the LYFT IPO that we didn't know already?Bayer AG pays the piper for another bundle of lawsuits related to blood-thinner Xarelto to complement its hellish ordeal with Monsanto subsidiary's Round-up. If Bayer is destined to founder in an ocean of liability lawsuits, what is the play for us? On ROBERT'S STOCK TIP CORNER, we discuss the merits of buying Dow DuPont, or not.

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James Williams, MS, DO, FACEP - NOAC Update

ACEP Frontline - Emergency Medicine

Play Episode Listen Later Jul 10, 2018 34:37

The popularity of NOACs has grown. Numerically, though they are safe, it’s likely that the Emergency Physician will see more and more bleeds, especially in a trauma situation. In early May, Portola Pharmaceuticals got FDA approval for the targeted reversal agent, Andexanet, as indicated for the reversal of Eliquis and Xarelto. Dr. Williams breaks down the research on this episode of ACEP’s Frontline. Support for this segment was provided in-part by Portola Pharmaceuticals.

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RX4Justice-Episode-1-XARELTO

NewMercuryMedia

Play Episode Listen Later Dec 13, 2016 11:00

RX4Justice is a Service that discusses issues of Relevance to those Seeking to Understand Medicine today Hosted by Richard W. Spisak who has investigated the issue of Xarelto today the state of Science today. LIVER DAMAGE Xarelto has produced significant cases of liver damage: another in a series of life-threatening complications arising from its use. Xarelto (rivaroxaban) a potential lethal agent has been shown to cause in some percentage of individuals both potential liver damage and serious hepatic injuries in a population of patients who have used it.. Controversial, and fast acting it can be a non-reversible an potentially quite dangerous blood thinner which has recently associated with several cases of serious and even lethal bleeding accidents. Additional potentially serious even fatal side effects are still under current post-marketing investigation. Among the serious reactions of this “rushed to market” blood thinner is the risk of significant liver damage or even failure reported when this drug as been used. Different, distinctly different from earlier drugs used in similar ways for example Warfarin, There’s no efficacious antidote available to reverse this blood thinner’s effects. Once a potentially fatal bleeding event begins, the physicians have no tool to to reverse the potential life threatening effects of potential severe injuries or even a fatality. A recent analysis of the results coming from three large international pharmacovigilance databases revealed a significant number of hepatic adverse reactions were rivaroxaban was reported as a suspected cause

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PE on Xarelto

Play Episode Listen Later May 16, 2016 3:39

A sad case is a lesson for not ruling out PE despite anticoagulation therapy.

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Andexanet for Xarelto?!

The David Steinberg Podcast

Play Episode Listen Later Apr 17, 2016 2:26

The potential new drug Andexanet is explained.

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#8: Kevin Nealon

Play Episode Listen Later Feb 9, 2016 27:12

Kevin Nealon, (known for SNL, Weeds, and those Xarelto commercials with Arnold Palmer) sits down with David for a fascinating discussion. They touch on the late Jan Hooks and her struggle with stage fright, what it was like starting stand up comedy in Los Angeles, and much more.

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Bloody Anticoagulants

Intensive Care Network Podcasts

Play Episode Listen Later Sep 2, 2015 18:32

Bloody Oral Anticoagulants – BCC talk 2014 The use of the New Oral Anticoagulant Drugs present unique challenges for the Intensive Care practitioner 1. The NOACs now have PBS approval for non-valvular AF, below knee DVT, DVT prophylaxis and low volume PE 2. There is no specific antidote for NOAC related bleeding but don’t despair there are some things that can help 3. Routine coagulation testing does not reflect drug levels or anticoagulation activity Global sales of Dabigatran topped $1billion in 2012. This talk outlines the pharmacodynamics and pharmacokinetics of the NOACs. Limitations and cautions of use are outlined with a review of the extensive literature. Clinical cases involving the NOACs are presented. The timing of stopping the agents before minor or major surgery, the approach to a patient with intracranial haemorrhage taking oral anticoagulants and the challenges faced when patients have an Acute Kidney Injury whilst taking these

Antistollingsmiddelen blijven omstreden

Argos

Play Episode Listen Later Feb 28, 2015 36:24

Nieuwe antistollingsmedicijnen met de merknamen Pradaxa en Xarelto worden sinds twee jaar vergoed door de Nederlandse zorgverzekeraars. Deze veel duurdere noac’s, de Nieuwe Orale Anti Coagulantia, kwamen versneld op de markt omdat ze grote voordelen zouden hebben ten opzichte van de traditionele bloedverdunners. Minder bijwerkingen, en een vaste dagelijkse dosis waardoor patiënten niet meer naar de trombosedienst hoeven om de stolling te laten controleren en daarmee de dosis van het medicijn te laten bepalen. De Gezondheidsraad eiste bij de invoering van de vergoeding een onderzoek in Nederland naar de effectiviteit en de veiligheid van de nieuwe middelen. Om ze zo te kunnen vergelijken met de oude, spotgoedkope bloedverdunners.Zijn de noac’s inderdaad veiliger ? Is er echt geen controle van de stolling meer nodig ? En hoe staat het met de studie waar de Gezondheidsraad om vroeg? Eerder, in december 2012 besteedde Argos aandacht aan de toen net ingevoerde Noac’s. Nu, ruim twee jaar later, kijken we of de waarschuwingen die medici toen uitten, bewaarheid zijn geworden. Argos over sterfgevallen, misleiding en het uitblijven van een beloofd onderzoek. Een reportage van Helene van Beek.

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003 - Novel Oral Anticoagulants (NOACs)

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Play Episode Listen Later May 6, 2014 26:00

In this episode, we discuss the new drug class of Novel Oral Anticoagulants (NOACs), which include dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis).

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FirstWord Pharmaceutical News for Monday, February 17, 2014

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Play Episode Listen Later Feb 17, 2014 7:19

Today in FirstWord:

FirstWord Pharmaceutical News for Friday, January 17, 2014

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Play Episode Listen Later Jan 17, 2014 9:02

Today in FirstWord:

FirstWord Pharmaceutical News for Friday, November 1, 2013

Play Episode Listen Later Nov 1, 2013 17:59

Today in FirstWord:

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FirstWord Pharmaceutical News for Friday, March 1, 2013