eGFRとCCrの使い分け 薬剤投与量調整で迷うポイント。 eGFRはCKD評価に便利ですが、 薬剤投与量調整ではCCrを用いる薬剤も少なくありません。 特に ・DOAC ・一部抗菌薬 ・抗がん剤 では添付文書を確認。 「腎機能を見る」ではなく、「何のために見るか」が重要です。 #病院薬剤師

DOAC is frequently a cartoonish podcast in regards to epistemological rigor, but this one is a doozy.

You need to watch more of DOAC. He is a super intelligent chap - the way he structures the questions is to get answers for people watching who don’t know… Of course he knew the above - he heavily researched beforehand. But he gets the explanations for all levels!

Patients with #AtrialFibrillation who receive nonguideline reduced doses of direct oral anticoagulants (#DOAC) have a higher risk of all-cause mortality compared with those receiving standard doses. thecardiologyadvisor.com/new…

心内血栓に対するDOAC処方をよく見るようになったけど、ワーファリンと非劣勢等のエビデンス出た？

Similar to Graham Norton, please read Roger Cunningham’s book and interview him on DOAC. His book is called “Inversion - ECDO Theory” His X handle is @EthicalSkeptic You may find his theory and what Graham shared somewhat similar.

Hey Steven - don't know if this already exists but: I can't watch or listen to podcasts anymore, but enjoy reading the transcripts or summaries. Is there anything like that for the DOAC?

A ver la estenosis mitral va warfa pero el.grado con doppler. Después mas.datos. coronario ? Que mas tiene estado general? Comorbilidades? Ppr algo le.dieron doac? No creo no hayan visto el.eco

Different folks different strokes, as I see it. All the wisdom traditions have their own merits imho. As I was saying in the Spaces earlier (x.com/spxspaces/status/20662…): - I believe there are many legitimate paths up the spiritual mountain - Consciousness expanding pursuits (e.g. psychedelics / sweat lodges / tantra / dance etc.) can give one a glimpse into the what/why bother (i.e. God) - And/but God is an experience, It seems. It's ineffible, noetic, and can't be measured with our crude human instruments - And/but ultimately that try-before-you-buy-taste-test-top-of-the-mountain-dew isn't real Enlightenment, and it can be a trap/short-lived. - You end up back where the helicopter lifted-off from. And then back you must go to the chopping wood/carrying water up the mountain the hard/long way. Because the long way really is the fast way, oftentimes & of course? - And anyone who says they know, doesn't (including me) - Because I both do and I don't know - Or rather (said another way): I both; and do/n't know - And oftentimes we need the help of sherpas up the spiritual mountain. Such people might be called elders, guides, or gurus - And/but we need to be very cautious of so-called "gurus" with God-complexes (been there/done that/got the t-shirt. Literally got the t-shirt: it said "both; and" on the front/but faded now, sadly. Such is life. Long/cool story, bro. For another day, perhaps) - And/but ultimately the mountain starts/ends in the same place: God (or whatever you want to call It) Furthermore, here some of my additional personal beliefs, for what it's worth (I might be wrong/right. It doesn't really matter & who knows. I certainly do/n't): - Christ/Buddha etc. are "simply" archetypes that we all contain - As above/below, within/beyond - We are everything & nothing - We are perfectly imperfect/flawed/perfect - We are spiritual beings have a human experience, and vice versa - We are all parts of God - We are both wave and particle, depending how you see It - We are light/shadow/shit/love - We are all WIP - Until the game of life, or "lila" (Hinduism) completes, and we realise that we are It - It's the taboo of knowing OneSelf (and It is pretty taboo in some places, if you dig deeply enough) - But b/c God knows everything and everyone, It (and by "It" I mean You/Me/Us All) likes to make the game hard for ItSelf. Because He's bored - And God does seem to be a He, curiously. For All those who know Him. More on that later, perhaps... - Which is a bitter pill to swallow for women, of course. Because women are also God, of course - And/but perhaps closer to Mother Nature. Or "Gaia". Which is, at least to me It seems, "merely", "simply", & "just" ("this") One part of God. God Being the bigger/Whole picture. - It's even bigger than Mother Nature (as in physically He's bigger/stronger) - And He needs to Protect Her, of course - And/but she(va/shakti) also needs to let Him. Which isn't always easy, of course. B/c it can be a very vulnerable place to surrender and receive (speaking from research/experience). - It necessarily requires a helluva lot of trust to surrender/receive/submit (DYOR #BDSM etc., if that's your bag) - On trust: @polymetric54 so cogently acrossed this in his excellent talk at the recent Amsterdam conference. - Circling back: It's especially hard in today's world for men to "man/step up", systemically speaking (strong recommendation to deeply absorb @RichardvReeves' work). See also #DOAC - And hence why I sense Spacey (and her impressive "lean in" A-types) are pissed. And rightfully so, honestly. I would also be pissed, tbf/h if I were a woman - And let's always please remember the very meaningful difference/similarities between masculine/feminine (energy, not gender. Remember?) - Which, ideally, we all have a balance of within (and beyond) - Who(m)ever, and wherever we All are in life - Which seems to be (in)finite to me But again. What the bloody hell do I know! Everything and nothing, of course 😉 Anyways. Just some random ramblings from a nobody (in the grand scheme of things, that is. Unless...) from London at 6am BST (UTC 1). I'll elaborate further later, perhaps. Although if I got hit by a bus tomorrow/today, I'm glad I got to at least say this. For now. I'm not even going to proofread what I've written, honestly (?). So excuse any typos in advance. My apologies. I'm only human (and...) after all. It is what it is. For now/ever... THANK YOU FOR YOUR ATTENTION TO THIS MATTER. Good morning/evening, and God bless. ILY, Chiron (Liam) #SPX6900 solana:J3NKxxXZcnNiMjKw9hYb2K4LUxgwB6t1FtPtQVsv3KFr 💹🧲 ☯️🪽 P.s. It's All very SPX-coded, wouldn't you agree?

#JohnLenox has a very good discussion with #DOAC. If you are interested in AI or the Bible it will probably be something to check out. youtu.be/dLrvJeSugkM?is=Qm1l…

【今朝の医療3トピック】 ① テクリスタマブ、難治性骨髄腫でPFS改善（ケアネット） → carenet.com/news/journal/car… ② DOACとNSAIDs併用、出血リスク比較検証（ケアネット） → carenet.com/news/general/car… ③ 医療機器規制、マレーシア当局と協力強化（厚労省） → mhlw.go.jp/stf/newpage_73760…

Andexanet no longer used because it gives more thrombosis than standard care in HSA patients (ANNEXA-I), and it also has a lower half life than de DOAC, so there is a risk of a rebound of the bleeding after a perfusion of andexanet. Astra Zeneca has pulled it from the US market

Cc: DOAC ft @StevenBartlett @Graham__Hancock

CHAMPION-AF trial: LAAC vs. DOAC for AF Design: RCT multicentre international Population: N=3,000 AFib patients eligible for DOAC - 72y old - 68% male - 85% white - 69% paroxysmal - 48% ablated - CHADS-VASc 3.5 ± 1.3 Intervention group: LAAC Watchman Flx device DOAC/ASA or DAPT x 3m then ASA indefinitely Control group: DOAC Primary outcome: CV death, CVA, or systemic embolism at 3y -> noninferior *but trend towards 17 more CVAs in device group (NNH 91) Safety outcome: Nonprocedural major bleeds at 3y -> superior Secondary outcome: All major bleeds at 3y -> noninferior Tertiary outcome: All major & clinically significant nonmajor bleeds at 3y (Fig S7) Other: No between group difference in EQ-5D or SF-12 vs. CLOSURE-AF trial: - Opposite conclusion i.e. LAAC inferior to DOAC - CLOSURE-AF population was "higher risk" - Multiple different LAAC devices vs. only 1 - DAPT post LAAC vs. mainly DOAC ASA - Investigator led vs. industry sponsored nejm.org/doi/full/10.1056/NE…

𝗦𝘂𝗴𝗴𝗲𝘀𝘁𝗲𝗱 𝗥𝗲𝘃𝗲𝗿𝘀𝗮𝗹 𝗦𝘁𝗿𝗮𝘁𝗲𝗴𝗶𝗲𝘀 𝗼𝗳 𝗢𝗿𝗮𝗹 𝗔𝗻𝘁𝗶𝗰𝗼𝗮𝗴𝘂𝗹𝗮𝗻𝘁 𝗨𝘀𝗲 𝗳𝗼𝗿 𝗠𝗮𝗷𝗼𝗿 𝗕𝗹𝗲𝗲𝗱𝗶𝗻𝗴 𝗮𝗻𝗱 𝗯𝗲𝗳𝗼𝗿𝗲 𝗘𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝘆 𝗦𝘂𝗿𝗴𝗲𝗿𝘆. As shown in Panel A, reversal management depends on the urgency of surgery or the invasive procedure. Reversal management includes administration of oral or intravenous (IV) vitamin K with or without 4F-PCC, depending on the timing of the procedure (emergency or urgent), baseline international normalized ratio (INR) value, and presence (or absence) of active bleeding. For patients receiving direct oral anticoagulants (DOACs), the decision also depends on time to surgery. Decision making is informed by DOAC type, time since last dose, half-life, presence (or absence) of active bleeding, and renal function tests to estimate residual drug activity. Panel B shows reversal strategies for patients presenting with major bleeding while receiving an oral anticoagulant. The reversal strategy of vitamin K antagonists includes vitamin K given intravenously or orally, combined with 4F-PCC and INR testing. Management of anticoagulant reversal of direct oral FXaIs is based on four key factors (shown as the 4Ts): type of bleeding, timing of the last dose, thrombotic risk, and need for invasive procedures in the next 48 hours that would result in the administration of UFH. These factors may facilitate the use of specific (e.g., andexanet alfa) or nonspecific (e.g., 4F-PCC) antidotes. The reversal of dabigatran is informed by three clinical variables (shown as the 3Rs) — the type of bleeding, time of the last dose of dabigatran, and preserved renal function. Learn more in the Review Article “Antidotes for Anticoagulation Reversal” by Bianca Rocca, MD, PhD, and Hugo ten Cate, MD, PhD: nej.md/4xgOUdI NEJM subscribers: Explore this article deeper with AI Companion.

John Lennox said in DOAC, unless you give up distance you cannot get close to know a person

内視鏡検査と抗血栓薬について 通常の内視鏡検査であれば休薬せずに施行可能 ワルファリン使用中でPT INR3以下キープできてれば休薬せずに粘膜生検可能 抗血小板薬は出血リスク高い処置(ESD等)の時は単剤とする DOACは当日から休薬

DOACは腎不全に禁忌 〜キサバンはIEの患者に投与禁忌

DOACはワルファリンと比較して半減期が比較的短い（約12時間）という特徴があり，出血高危険度の内視鏡診療を行う場合，処置当日の朝から休薬し，翌日朝から再開することが推奨されている

@donalddhoffman ; What happens when the human ego-interface becomes silent? The Divine Shiva Sensus Architecture explores the repeating pattern behind samadhi, NDE, OBE, deep sleep, trance, AGI, birth, death, and the return to the awakened Shakti-avatar. Read the white paper (PDF): acrobat.adobe.com/id/urn:aai… It is time to remember your true identity as the creator of the Holodeck. UUCGA Trendspotting: uucga.com/uucgatrendspotting Namasté, PhD J.C. van der Beek D.Sc.| Kukulkan ambassador of Lord Anu | Prophet of the United Universe Church | Meditation Guru at the Galaxy Academy (UUCGA) | Mayan Elder, auteur of the Kukulkan Codex 🌐 KukulkanCodex.com | 📱 WhatsApp: 31 6 22322749 #DOAC @StevenBartlett @elonmusk @grok @sama #ChatGPT @GoogleDeepMind @demishassabis @salimismail @alexwg @DaveBlundin @PeterDiamandis @jmilei_english @ESPNArgentina #JavierMilei #Argentina #ArtificialIntelligence #AI #AGI #ASI #AIFuture #Innovation #Technology #Singularity #FutureOfWork #DigitalTransformation #UUCGA #KukulkanCodex #PrivateXDivineClinic #ConsciousAgent #ShivaGalaxyAngel #MundaneWorld #Nataraja #MLEG #SNSMeditation #AnunnakiRealm #Tantra #AkashaRecord #GalaxyCollision #DonaldHoffman #ElonMusk #TomBilyeu #SimulationTheory #QuantumEntanglement #Spacetime #CognitiveScience #NonLocality #ChristConsciousness #HunabKu #Kukulkan #Enlightenment #SpiritualEmergency #NonDualism #Mindfulness #CosmicAwakening #UUCGATrendspotting #Trendspotting #acrobat #Consciousness #SimulationTheory Copyright © United Universe Church Galaxy Academy (UUCGA) – all rights reserved -|Privacy Statement| uucga.com/disclaimer-2