Public health

News in brief: Prognostic tool for low gradient AS; Dentists still stop DOACs before tooth extractions; Hospital doctors bullied to discharge patients early

Tuesday, 29 Jun 2021

Prognostic tool developed for people with low gradient AS

The Cardiac Damage Staging Classification is a simple and powerful prognostic tool to help guide management decisions in ‘low-gradient’ patients with severe aortic stenosis (AS), Australian cardiologists have shown.

A study led by Prof David Celermajer of the University of Sydney investigated the assessment of echocardiographic extra-AV cardiac damage at diagnosis and its association with outcomes for 2,500 patients with severe ‘low-gradient’ AS.

After a mean follow up of more than seven years (88 months) they found there was a strong association between cardiac damage stage and medium to long-term survival in classical “low-flow, low-gradient” (LFLG) severe AS, paradoxical LFLG and normal-flow, low-gradient (NFLG) patients.

The findings are published in Journal of the American Society of Echocardiography

Patients still have anticoagulants stopped before tooth extractions

One in three dentists are advising patients to stop anticoagulants before a tooth extraction, despite guidelines saying this is unnecessary and may put patients at risk of serious cardiovascular thrombotic events.

A survey of 89 dental practitioners in WA found that  32.6% said they would stop DOACs and 29.2% would advise stopping warfarin prior to an extraction.

The authors of the study said that regardless of the dental procedure, the risk of thromboembolism, stroke and myocardial infarction from stopping anticoagulation far outweighed the consequences of prolonged bleeding which can usually be controlled with local measures including placement of a haemostatic agent, closure with sutures and use of tranexamic acid.

“Hence, for most dental procedures, VKAs and DOACs must be maintained,” they wrote in the Australian Dental Journal..

They concluded that the knowledge gap in understanding of anticoagulant risk and benefits “may be something that requires action through the dental curriculums i.e. through the Australian Dental Council”.

“It is possible that there needs to be detailed guidelines in Australia to aid dentists managing the patients on anticoagulant and/or antiplatelet therapy,” they added.

Hospital doctors bullied to discharge patients early

More than 60% of hospital doctors feel coerced to discharge patients before they are medically ready, according to a survey conducted by the SA Salaried Medical Officers Association.

Almost 40% of doctors said the pressure to discharge patients came from hospital executives and half said the early discharges negatively impacted on care, according to report In Daily.

The survey supports a “Time to Care” campaign by SASMOA which says that medical care is being compromised by lack of staff numbers to meet demand and lack of time to provide appropriate medical care for patients.

“Medical decisions should be made by doctors based on a medical assessment of patient need and not based on cutting costs,” the Association said.

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