TY - CHAP M1 - Book, Section TI - Applying Results to Individual Patients A1 - Dans, Antonio L. A1 - Dans, Leonila F. A1 - Agoritsas, Thomas A1 - Guyatt, Gordon A2 - Guyatt, Gordon A2 - Rennie, Drummond A2 - Meade, Maureen O. A2 - Cook, Deborah J. PY - 2015 T2 - Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed AB - CLINICAL SCENARIOA 66-year-old man of Chinese ethnicity visits you at your clinic for a periodic health examination. He is a retired professor from a local university, regularly wins games at the local chess club, and is physically active. However, his medical history reveals that he experienced a mild stroke 2 years ago. He still feels some heaviness in his left arm and lower extremities, but his speech has returned to normal and he is independent in his daily activities. He is even able to jog 2 km daily at a slow pace. He has never smoked. He drinks 2 to 3 glasses of wine every day. Further inquiry reveals that he has primary hypertension and type 2 diabetes mellitus and that he was diagnosed as having atrial fibrillation (AF) a year before his stroke.The physical examination findings are unremarkable except for a blood pressure of 130/90 mm Hg and an irregular heart rate of 64/min. An electrocardiogram confirms that he indeed has AF.The patient is taking 500 mg of metformin twice a day for his diabetes and 10 mg of ramipril once a day for his hypertension. Both the diabetes and hypertension have been well controlled for the past year. His only drug for stroke prevention is aspirin, 325 mg once a day.Because the patient has a high risk for a recurrent embolic stroke, you consider prescribing an oral anticoagulant. You have used mostly warfarin in your practice, but in the past year, you have been discussing dabigatran etexilate, a novel anticoagulant recently approved by the US Food and Drug Administration for stroke prevention in AF, with some of your patients. Recently, you have heard concerns about the safety of warfarin among Asians, so you wonder if dabigatran would be a better choice for this patient. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - jamaevidence.mhmedical.com/content.aspx?aid=1183876565 ER -