Sarah Spinler

Binghamton University | SUNY Binghamton · Pharmacy Practice School of Pharmacy and Pharmaceutical Sciences

Objective: Results from large placebo-controlled randomized trials in patients with heart failure with mid-range ejection fraction (HFmrEF) and HF with preserved EF (HFpEF) have become available recently. This article discusses results of these clinical trials. Data sources: Peer-reviewed articles were identified from MEDLINE (1966 to December 3...

Despite the many advances in cardiovascular medicine, decisions concerning the diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues in current practice are increasingly complex, inclu...

Purpose We describe the structure, implementation, and initial evaluation of a formal residency research certificate program (RRCP) designed to further advance residents’ knowledge and skills in research in an effort to better prepare residents for research involvement during their careers. Summary Pharmacy residency programs vary in the degree of...

Coronavirus disease of 2019 (COVID-19) is the respiratory viral infection caused by the coronavirus SARS-CoV2 (Severe Acute Respiratory Syndrome Coronavirus 2). Despite being a respiratory illness, COVID-19 is found to increase the risk of venous and arterial thromboembolic events. Indeed, the link between COVID-19 and thrombosis is attracting atte...

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Introduction: Recent clinical trials evaluating the efficacy of aspirin in primary prevention of atherosclerotic cardiovascular disease (ASCVD) have suggested the risk of aspirin may outweigh its benefit in individuals once thought to be candidates for aspirin therapy. These results led to the publication of updated guideline recommendations in 20...

Sodium-glucose cotransporter (SGLT2) inhibitors have demonstrated cardiovascular (CV) benefits in large-scale clinical trials of people who have type 2 diabetes and either established CV disease or multiple CV risk factors. These studies also indicated early signals in benefiting heart failure (HF) patients and those with chronic kidney diseases. T...

Objective: While improving glycemic control with antihyperglycemics has been demonstrated to reduce microvascular complications, the benefits of reduction in cardiovascular diseases (CVDs) have not been demonstrated with older agents. This article reviews current evidence of the CV outcomes of newer antihyperglycemics approved since 2008. Data so...

Objective: In 2016, the American College of Cardiology released a decision pathway, based on expert consensus, to guide use of non-statin agents in the management of atherosclerotic cardiovascular disease risk. The purpose of this article is to assist practitioners, health systems and managed care entities with interpreting this consensus statemen...

Anticoagulant drugs are the foundation of therapy for patients with VTE. While effective therapeutic agents, anticoagulants can also result in hemorrhage and other side effects. Thus, anticoagulant therapy selection should be guided by the risks, benefits and pharmacologic characteristics of each agent for each patient. Safe use of anticoagulants r...

Objectives: To compare and contrast the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines and the 2014/2015 National Lipid Association (NLA) Recommendations for Management of Dyslipidemia in the context of evolving evidence. Data sources: Guidelines from the National Cholesterol Education Program (NCEP), ACC/A...

Anticoagulant drugs are the foundation of therapy for patients with VTE. While effective therapeutic agents, anticoagulants can also result in hemorrhage and other side effects. Thus, anticoagulant therapy selection should be guided by the risks, benefits and pharmacologic characteristics of each agent for each patient. Safe use of anticoagulants r...

Studies have found that non-high-density lipoprotein cholesterol (non-HDL-C) is a superior marker for coronary heart disease compared to low-density lipoprotein cholesterol (LDL-C). Little is known about achievement of non-HDL-C goals outside clinical trials. Within a population of 146,064 patients with dyslipidemia in the PINNACLE Registry and a s...

To review the pharmacology, efficacy, and safety of vorapaxar, a protease activator receptor-1 (PAR-1) antagonist, in the management of atherosclerotic diseases. Peer-reviewed clinical trials and review articles were identified from MEDLINE and Current Content database (both 1966 to December 31, 2014) using the search terms vorapaxar and protease a...

Since 2003, the Seventh Report of the Joint National Committee (JNC 7) has been the predominant guideline for blood pressure management. A 2014 expert panel recommended increasing the blood pressure targets for patients age 60 years and older, as well as those with diabetes or chronic kidney disease.Objectives The purpose of this study was to exami...

Current percutaneous coronary intervention (PCI) guidelines recommend the use of a P2Y12 inhibitor with aspirin and an injectable anticoagulant. However, available oral P2Y12 inhibitor therapy is limited by significant drug interactions, unclear oral absorption in selected clinical conditions, and delayed onset and offset of activity that may be cu...

Rivaroxaban is the first agent available within a new class of anticoagulants called direct factor Xa inhibitors. Rivaroxaban is approved for use in the United States for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, for the prevention of deep vein thrombosis in patients undergoing total hip replac...

Myopathy and rhabdomyolysis resulting from the coadministration of simvastatin and amiodarone have previously been described.¹,² To minimize this risk, FDA has limited the maximum dosage of simvastatin to 20 mg daily when coadministered with amiodarone.² However, doses of simvastatin 40 and 80 mg daily are still commonly coprescribed with amiodaron...

Cardiac transplant patients are at risk for developing cardiac allograft vasculopathy, and dyslipidemia in this patient population has been associated with increased risk. Data evaluating the efficacy and safety of ezetimibe in this population are minimal. The purpose of this study was to assess the effects of ezetimibe, alone or in combination wit...

Background: Medication therapy management (MTM) is a mandated component of the 2003 Medicare Modernization Act for Part D prescription drug plans and Medicare Advantage plans, authorizing the pharmacist or other qualified provider to identify, resolve, and prevent medication-related problems for patients with chronic diseases. MTM programs have be...

Patients experiencing atrial fibrillation are at an increased risk for thromboembolic events. Therefore, anticoagulation therapy is imperative to prevent thrombus formation and stroke. Dabigatran etexilate was approved by the Food and Drug Administration in 2010 as anticoagulant prophylaxis for patients with nonvalvular atrial fibrillation. The fre...

Dabigatran etexilate is an oral prodrug of dabigatran, a direct thrombin inhibitor, that provides the first available oral anticoagulant alternative to warfarin for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF). Although warfarin is effective, many patients with AF remain undertreated, prima...

Background: Currently available anticoagulants utilized for venous thromboembolism (VTE) treatment and prevention and stroke prevention in patients with atrial fibrillation (AF) have proven effectiveness but are not optimally utilized because of barriers such as the need for subcutaneous administration and requisite routine laboratory monitoring....

More than 1 million people in the United States experience an acute coronary syndrome (ACS) every year, and almost 600,000 undergo percutaneous coronary intervention (PCI) for treatment of cardiovascular disease. There is a large amount of evidence-based literature to guide appropriate management of these patients. There have been a number of advan...

The American College of Clinical Pharmacy charged the Public and Professional Relations Committee to develop a short white paper describing quality measures of clinical pharmacists' patient care services in transitional care settings. Transitional care describes patient movement from one health care setting or service to another. Care transitions a...

Case 1A : A 68-year-old man with a past medical history of atrial fibrillation (AF), hypertension, and type 2 diabetes mellitus has been on anticoagulation therapy with warfarin for 6 years. The patient's target international normalized ratio (INR) is 2.0 to 3.0. The patient has been managed by a pharmacist-run anticoagulation clinic, and his recen...

A number of novel anticoagulants are moving through various stages of drug development. Recently, the United States Food and Drug Administration approved the oral direct thrombin inhibitor dabigatran etexilate to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Although dabigatran offers a number of...

Background: Medication Therapy Management (MTM) is a mandated component of Medicare Part D whereby a pharmacist-patient encounter identifies, resolves and prevents medication-related problems. MTM programs have been shown to improve drug therapy goal attainment while reducing overall costs in cardiac patients; however, MTM has been greatly underuti...

IntroductionAnticoagulation in Patients with Chronic Kidney DiseaseAnticoagulation in Obese PatientsReferences

To provide a comprehensive review of the pharmacology, pharmacokinetics, pharmacodynamics, clinical trial data, adverse effects, and drug interactions of apixaban. An English-language literature search was performed with MEDLINE/PubMed from January 2007 to August 2011 using the search terms apixaban, factor Xa inhibitors, FXa inhibitors, BMS-562247...

Dabigatran etexilate is a prescription medication used to slow and inhibit the formation of blood clots. Dabigatran is known by the trade name Pradaxa in the United States and all other countries in which it is marketed except Japan (Prazaxa) and Canada (Pradax). Although forming blood clots is a normal and important body function needed to stop bl...

Acute coronary syndrome (ACS) is a continuum of disease that includes non-ST-segment elevation ACS and ST-segment elevation myocardial infarction. The purpose of this article is to define the developing role of ticagrelor in ACS and compare it to currently available P2Y₁₂ receptor inhibitors. While clopidogrel remains the "workhorse" P2Y₁₂ receptor...

Warfarin is a complex but highly effective treatment for decreasing thromboembolic risk in atrial fibrillation (AF). We examined contemporary warfarin treatment rates in AF before the expected introduction of newer anticoagulants and extent of practice-level variation in warfarin use. Within the National Cardiovascular Data Registry Practice Innova...

Prasugrel is the most recent addition to the available thienopyridine antiplatelet agents used to prevent ischemic events in patients with acute coronary syndrome undergoing percutaneous coronary intervention. The aim of this article was to review published data on the efficacy and safety profile of prasugrel, cost considerations with its use, and...

Beginning in 2009, the Joint Commission implemented National Patient Safety Goal (NPSG) 3E (now called NPSG 03.05.01) to “reduce the likelihood of harm associated with the use of anticoagulation therapy.”[1][1] One of the elements of performance of this goal is that hospitals “use approved

Current guidelines recommend using bivalirudin, a direct thrombin inhibitor,as a preferred alternative to unfractionated heparin in patients with heparin induced thrombocytopenia (HIT) for percutaneous coronary intervention, as well as for cardiac and vascular surgery. Anticoagulation during radiofrequency catheter ablation (RFA) procedures may be...

The benefits and risk of bleeding associated with oral antiplatelet agents used for acute coronary syndrome (ACS) or in patients who have undergone percutaneous coronary intervention (PCI) are discussed. Over the past decade, significant advances have been made with the use of oral antiplatelet agents in ACS patients and in those undergoing PCI and...

Nat. Rev. Cardiol. 7, 10–11 (2010); doi:10.1038/nrcardio.2009.220 In the January 2010 issue of Nature Reviews Cardiology, an error was published in the third sentence of the fourth paragraph of the News & Views article by Sarah A. Spinler. The sentence should have read “These benefits, however, were observed at a cost of two myocardial infarctions...

Medical errors are the eighth leading cause of death in the United States and are estimated to account for somewhere between 44 000 and 98 000 deaths in the United States each year.1 An exact number of deaths remains both uncertain and controversial, with arguments that the actual figure may be lower2 or higher.3 Each year in the United States, the...

Stroke is the leading cause of morbidity and mortality in patients with atrial fibrillation. whereas warfarin reduces the risk of stroke, its interactions with other drugs and food, individual differences in its efficacy and the need for frequent monitoring make its use inconvenient. dabigatran etexilate might represent a step forward in the care o...

The American Heart Association/American College of Cardiology guidelines recommend initiating a proton-pump inhibitor (PPI) to prevent gastrointestinal bleeding if patients are receiving concomitant therapy with clopidogrel and aspirin. Recently, concern has been raised regarding the ability of PPIs to decrease the antiplatelet activity of clopidog...

This report concerns a case of torsades de pointes (TdP) associated with the concomitant administration of methadone and voriconazole in a patient with comorbid medical conditions. A 57-year-old man, with a medical history of human immunodeficiency virus, infective endocarditis, hepatitis C and orbital Aspergillus infection, was admitted to the int...

Purpose: Mechanical circulatory assist devices (MCAD) require anticoagulation which is complicated by considerable concern for post-operative bleeding risks. There is very limited data available for guidance on anticoagulation dosing in such patients. Methods: Prospective evaluation of early- and late-postoperative heparin dosing nomograms in patie...

Practitioners in US hospitals are implementing anticoagulation dosing and monitoring protocols to improve the safety of anticoagulation, consistent with National Patient Safety Goal 03.05.01. An audit of the Utrecht Patient Oriented Database of patients treated with low-molecular-weight heparin (LMWH) at the University Medical Center Utrecht reveal...

Aggressive secondary prevention is critical to improving long-term outcomes in patients with ischemic coronary artery disease, cerebrovascular disease, and peripheral artery disease. An essential component of successful secondary prevention is antiplatelet therapy, which in most patient populations consists of aspirin, clopidogrel, aspirin plus clo...

The role of platelets in atherothrombotic disease is well established, and antiplatelet therapy is now recommended for the shortand long-term management of patients with acute coronary syndromes (ACS), with and without percutaneous coronary intervention (PCI). The thienopyridine clopidogrel is accepted as a key component of antiplatelet management...

To develop practical recommendations for the use of low-molecular-weight heparins (LMWHs) as prophylaxis and treatment of venous thromboembolism and acute coronary syndromes in patients with impaired renal function or obesity. Multiple MEDLINE searches were performed (November 2008) to identify studies for inclusion, using a comprehensive list of s...

To evaluate how enoxaparin is dosed in contemporary clinical practice as a function of patients' total body weight (TBW) and body mass index (BMI), and to determine any association between dose and major bleeding. Retrospective cohort study. The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implement...

Percutaneous coronary intervention (PCI) with stenting is increasingly being utilized for acute coronary syndromes (ACS), and the debate over the safety and efficacy of drug-eluting stents (DESs) versus bare-metal stents (BMSs) has intensified. The difficulty in consistently assessing stent safety is because of the widespread off-label use in patie...

Chronic kidney disease (CKD) is a risk factor for coronary heart disease and bleeding with antithrombotic therapy in patients with acute coronary syndromes (ACS). We evaluated the effect of renal function on efficacy and outcomes in high-risk patients with NSTE ACS in the SYNERGY trial. Creatinine clearance (CrCl) at the time of randomization was a...

Atrial arrhythmias, ventricular arrhythmias, and sudden cardiac death (SCD) are significant health problems and an economic burden to society. The renin-angiotensin-aldosterone system (RAAS) may play a key role in the occurrence of structural and electrical remodeling, potentially explaining the development of atrial and ventricular arrhythmias. An...

As the only oral anticoagulation option available in the United States, warfarin use remains widespread. However, concerns of safety remain a substantial issue. Additional anticoagulation options include unfractionated heparin, low-molecular-weight heparins (e.g., enoxaparin, dalteparin, and tinzaparin), and the indirect-acting factor Xa inhibitor,...

Obese patients are at increased risk of acute coronary syndromes (ACS). We evaluated the prevalence of obesity in a large ACS population, as well as the relationship between body mass index (BMI) and the use of cardiac medications and procedures, clinical outcomes, and treatment effects between enoxaparin and unfractionated heparin (UFH). Using the...

Elderly patients are at high risk from non-ST-segment elevation acute coronary syndromes (NSTE ACS) as well as from treatment-related complications. Age-associated changes in physiology may alter the risk and benefit expected from therapy. The SYNERGY database was used to study the influence of age on treatment outcomes with enoxaparin vs. unfracti...

To review the rationale, clinical practice guideline recommendations, and clinical trial data describing bleeding and clinical outcomes associated with the use of the combination of aspirin, a thienopyridine, and warfarin. An English-language literature search was conducted using MEDLINE (1966-March 2008) and the search terms aspirin, clopidogrel,...

Our purpose was to compare formulae for estimating glomerular filtration rate (GFR) in non-ST-segment elevation acute coronary syndromes (NSTE ACS) patients. Assessment of GFR is important for antithrombotic dose adjustment in NSTE ACS patients. We assessed estimated glomerular filtration rate (eGFR) with Cockcroft-Gault (C-G) and Modification of D...

Clinical evidence in the management of acute coronary syndromes (ACS) and in percutaneous coronary intervention (PCI) continues to evolve at a rapid pace. For clinicians to provide optimal care for these patients, it is important to keep up with new information as it becomes available. With the existence of numerous pharmacologic agents, abundance...

Non-ST-segment elevation acute coronary syndrome (NSTE ACS) consists of unstable angina and non-ST-segment elevation myocardial infarction. The estimated annual 1.4 million hospital admissions attributed to these life-threatening conditions create a significant cost burden to institutions due to associated cardiovascular operations or procedures su...

Evidence-based clinical practice guidelines encapsulate current knowledge to guide health care professionals in the treatment of patients with unstable angina or non-ST-segment-elevation myocardial infarction (NSTEMI), yet adherence to guideline recommendations is suboptimal. Guideline adherence may be improved by quality improvement programs such...

Patients who undergo intracoronary stent placement during percutaneous coronary intervention (PCI) have reduced rates of restenosis and acute vessel closure compared with patients who undergo balloon angioplasty.[1][1] Drug-eluting stents (DESs), such as Cypher (Cordis Corp., Miami Lakes, FL) (

To describe data and insights from a national quality improvement initiative known as Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines (CRUSADE), for managing non-ST-segment elevation acute coronary sy...

To evaluate the level of agreement between two sets of criteria, the Thrombolysis in Myocardial Infarction (TIMI) criteria and investigator-developed criteria, for identifying bleeding events in patients who had undergone a percutaneous coronary intervention (PCI) and to measure length of hospital stay (LOS) as a surrogate marker of bleeding severi...

Approximately 2500 Americans die from cardiovascular disease (CVD) each day. Each year, CVD claims more lives than the next four leading causes of death combined. Direct and indirect costs of CVD are estimated to be Dollars 403.1 billion in 2006. Despite advancements in conventional therapy, the residual risk of CVD continues to rise. One component...

Significant advances in pharmacotherapy for patients undergoing percutaneous coronary intervention (PCI) have occurred during the past decade, including the introduction and approval of new antithrombin and antiplatelet therapies, as well as modifications in dosing, administration, and/or duration of older pharmacotherapy regimens. Also, off-label...

Understanding the mechanisms of drug interactions with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has become increasingly important because of the potential for serious adverse effects, most notably myopathy. Most of the evidence supports the role of cytochrome P450 (CYP) isoenzymes in many of these drug interactions. Howe...

To review and discuss key aspects of the drug therapy recommendations in the American College of Cardiology (ACC)/American Heart Association (AHA) 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure (HF) in the Adult. Data were obtained from the ACC/AHA 2005 Guideline Update for Chronic HF. English-language clinical tria...

To review the incidence, risk factors, mechanism, times of onset and resolution, and treatment of hyponatremia associated with selective serotonin-reuptake inhibitors (SSRIs). An English-language literature search was conducted using MEDLINE (1966-December 2005) using the search terms selective serotonin-reuptake inhibitor, hyponatremia, syndrome o...

ST-segment-elevation myocardial infarction (STEMI) is a serious condition that requires early, aggressive management to reduce infarction damage and the risk of mortality. Although evidence-based guidelines recognize the clear benefits of early, effective reperfusion in STEMI, a number of barriers interfere with prompt delivery of care. Delays in t...

To determine the risk factors for venous thromboembolism (VTE) and the rates of prophylactic measures used in acutely ill medical patients. Prospective observational study. Academic tertiary care medical center. One hundred seventy-nine patients admitted to three general medical units over 30 consecutive days and hospitalized for at least 3 days. O...

To describe 2 cases of rash that occurred following oral administration of both clopidogrel and ticlopidine and to review previously published case reports. Two patients developed maculopapular pruritic rashes that began on the abdomen and spread to the back, neck, and face following clopidogrel administration after placement of a drug-eluting intr...