Bioprosthetic aorta valves are recommended for those > 70 years of age because of their reduced durability compared to mechanical valves and mechanical prostheses, which are recommended for those < 60 years because bioprosthetic valves deteriorate more rapidly in younger individuals.
Due to the short half-life and rapid onset of action of the new oral anticoagulants (NOACs), peri-procedural anticoagulant free time intervals should be shorter than with warfarin. Thus, there is uncertainty about the use of heparin bridging.
Because of its strong efficacy, long-term durability, and predictability when titrated with algorithms employed in clinical trials, basal insulin remains a mainstay of treatment for type 2 diabetes patients who are not able to attain or maintain glycemic control with oral agents alone. Because diabetes is a progressive disorder, even patients who are initially well-controlled on basal insulin will likely require “fine tuning” of their diabetes regimen, usually with agents that preferentially affect postprandial glucose levels.
The probiotic movement is rapidly growing and, although to date no probiotics have been approved by the FDA, they are actively marketed to the public as either foods or dietary supplements. It behooves the primary care physician to be familiar with the science, indications, and appropriate usage of probiotic therapies.
Patients with unprovoked venous thromboembolism (VTE) are at high risk of recurrence after discontinuation of vitamin K antagonist (such as warfarin) therapy, with an approximately 10% risk of recurrence within the first year and 5% risk per year thereafter.