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東日本大震災の地盤沈下 最大30センチ以上隆起 (NHK)

東日本大震災の直後、東北や関東などの沿岸部を中心に最大で1メートル余り沈下した地盤は元に戻る動きが続き、当時と比べて最大で30センチ以上隆起していたことが、国土...

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[Vitamin K antagonists : Is their prescription really "medical malpractice" today?]

著者 Rafflenbeul E , Müller-Ehmsen J
Internist (Berl).2017 Jan 05 ; ():.
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Atrial fibrillation and venous thromboembolisms are frequent cardiovascular diseases. Until a few years ago only vitamin K antagonists (VKA) were available for oral anticoagulation as primary and secondary prevention of thrombembolic events. Currently, the non-vitamin K dependent new oral anticoagulants (NOAC) dabigatran, rivaroxaban, apixaban and edoxaban are approved for use. The approval studies, meta-analyses and data from registries provide evidence for the superiority of NOAC vs. VKA with respect to reduction of thrombembolisms and reduced bleeding complications; therefore, in the 2016 European Society of Cardiology (ESC) guidelines the use of NOAC is recommended as first line therapy for anticoagulation in atrial fibrillation (recommendation grade I/evidence level A). In patients with mechanical heart valve replacement and severe renal dysfunction VKA are still clearly indicated. This also holds true for prophylaxis of secondary thromboembolic events in tumor patients. Thus, even today therapy with VKA must not be regarded as medical malpractice, especially when a good adjustment of the international normalized ratio can be achieved; however, for many patients NOAC represent a very good alternative and lead to at least equal results with less effort for the prescribing physician and the patient.
PMID: 28058458 [PubMed - as supplied by publisher]
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