The Gensel Lab's objective is to determine how to harness reparative capabilities of inflammation in spinal cord injuries.

UK researchers discuss the search for cures to spinal cord injuries

John Gensel, an assistant professor in the physiology department and the Spinal Cord and Brain Injury Research Center, and two members of his lab team – Bei Zhang and Taylor Otto – were featured in the most recent UK Research Media podcast.

Taylor Otto, an undergraduate lab assistant in Gensel’s lab, described UK as being the full package. “We have it all here. It’s a good program to be able to come into, not really knowing what you want to exactly do in the science field, but being able to figure it out at the same time,” said Otto.

Bei Zhang, a research scientist, said that working with Gensel has motivated her to do the best science she can. “If we can work at our research project every day in generating different thoughts and prove our hypothesis, we can make a contribution to the cure for spinal cord injuries.”

The team’s objective is to determine how to harness reparative capabilities of inflammation in spinal cord injuries. “Our goal is to really find out what physiological factors regulate the reparative or pathological balance, and gain insights into developing therapies for that,” said Gensel. “The overall goal is to improve the lives of individuals with a spinal cord injury.”


You can listen to the full podcast below:


Next steps:

  • Learn more about spinal cord injuries and what makes them so difficult to treat.
  • The UK Spine Center brings together orthopaedic experts and neurosurgeons for an advanced approach to spine care.
UK Sanders-Brown had its annual Markesbery Symposium on Aging and Dementia last week. Speakers discussed healthy brain aging and self-care for caregivers.

Healthy brain aging the focus of Sanders-Brown symposium

UK Sanders-Brown Center on Aging (SBCoA) hosted its sixth annual Markesbery Symposium on Aging and Dementia last week with speakers focused on healthy brain aging and self-care for caregivers. The two-day program offered sessions for both scientific and community audiences.

On Friday, Nov. 4, the scientific session in the UK Chandler Hospital Pavilion A auditorium featured speakers Dr. Gary Small of UCLA and Dr. Julie Schneider of Rush University, who presented their latest findings and answered questions from the audience.

The science behind healthy brain aging

Schneider provided an overview of her observations that, there are brain changes in addition to the well-characterized plaques and tangles that may also cause cognitive dysfunction and dementia.

Small gave the audience an overview of the scientific underpinnings for the hypothesis that lifestyle changes – including diet and exercise — can be protective against Alzheimer’s disease, particularly when combined with pharmacological therapies.

Afterward, Sanders-Brown Center on Aging faculty members Joe Abisambra, PhD; Harry LeVine, PhD; Peter Nelson, MD, PhD; and Linda Van Eldik, PhD, presented findings from their latest research.

Caring for the caregivers

On Saturday, Nov. 5, the Bluegrass Ballroom at the Lexington Convention Center was filled with close to 300 members of the community who came to hear Dr. Small and Mary Austrom, PhD, of Indiana University.

Small has authored or co-authored several books on memory and memory loss, including “The Alzheimer’s Prevention Program,” “2 Weeks to a Younger Brain,” and the international best-seller “The Memory Bible.” Dr. Small shared with the audience his recommended techniques for healthy brain aging.

Austrom is an expert on late-life transitions and adjustment to retirement. She is also interested in non-pharmacological interventions for dementia patients and their caregivers, and the stress and grief associated with caring for someone with dementia.

Austrom spoke on the burden of caregiving and the importance of ensuring adequate respite for caregivers.

SBCoA leads the way in Alzheimer’s research

Following the formal presentations Austrom, along with Sanders-Brown’s own Dr. Gregory Jicha and Marie Smart, answered questions from the audience ranging from the challenges of caring for someone with dementia to end-of-life decision-making to the need for early and accurate diagnosis, and what is on the horizon with respect to research and clinical trials.

“It’s always invigorating to have clinicians and researchers from UK and other institutions come together to share current findings and trends on dementia and aging,” said Van Eldik, director of the Sanders-Brown Center on Aging. “We consider it part of our responsibility as a world leader in Alzheimer’s research to foster collaboration among institutions and share our insights with members of our community.”

The Markesbery Symposium is named in honor of the late Dr. William R. Markesbery, the founder and long-time director of the UK Sanders-Brown Center on Aging and an internationally renowned expert on aging and dementia.


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Carlee with Dr. Jessica Lee

Advanced medicine saved her life. This is how she said thank you.

Courtney Wilson’s life very nearly ended in 2013. She credits Dr. Jessica Lee and the stroke team at UK HealthCare with saving her.

The 30-year-old preschool teacher’s assistant from Russell County awoke one morning “feeling awful,” she said. She dropped her 2-year-old off at daycare and took her 5-year-old to school, then popped into the school nurse’s office for advice.

“All I could tell her was that I felt really bad and that my balance was off,” said Courtney.  “The nurse drove me to the Emergency Room right away.”

At Russell County Hospital, emergency room doctors examined her carefully but could find no other symptoms to explain Courtney’s troubles.  They consulted with Dr. Lee, director of UK HealthCare’s Stroke Center, who advised them to administer the clot-buster drug called TPA and send Courtney immediately to UK Chandler Hospital.

Lee and her team from UK’s Kentucky Neuroscience Institute were similarly confused by Courtney’s mysterious lack of neurological deficits.  But Comprehensive Stroke Centers like the one at UK HealthCare follow specific procedures when evaluating possible stroke patients. So, as part of UK’s routine screening process, Lee ordered a CT angiogram, which provides doctors with images of the vessels that supply oxygen-rich blood to the brain.

“When we pulled her scan up on the screen, it was shocking news,” Lee says. “We were stunned.”

Courtney had a thrombus — a blood clot — in what’s called “the artery of life.” This artery is the superhighway of arteries, serving areas of the brain that control heartbeat and breathing. Courtney was on the precipice of a massive stroke.

“I literally ran to her hospital room,” remembers Lee, “and sure enough, she was deteriorating before my eyes.  We absolutely scrambled from there.”

UK is fortunate to have a “dream team” trained to handle emergencies like this one.  Dr. Abdulnasser Alhajeri is an interventional neuroradiologist — one of only about 300 in the U.S. — and Dr. Justin Fraser is an endovascular neurosurgeon. Both doctors are able to navigate tools such as tiny catheters, wires and other devices through blood vessels to diagnose and treat illnesses of the spinal cord and brain — also known as the central nervous system. Because this requires only a tiny incision in the groin instead of the larger incision necessary for open surgery, hospital stays and recovery times are faster, complications are less likely, and patients can return home to their families more quickly.

But, in what Lee describes as “the perfect storm,” both Drs. Fraser and Alhajeri were in other operating rooms on separate cases.

Time for Plan B.

Lee assembled a second surgical team to perform the preliminary phases of the procedure. “I didn’t even wait for transport to come get Courtney,” says Lee.  “Our Stroke Unit senior staff and I took her to the surgical suite ourselves.”

Then, as if choreographed, Dr. Alhajeri stepped from one room to the next and began to work on Courtney. Using high-tech precision imaging to watch its progress, Alhajeri positioned the catheter in Courtney’s brain, attached a large syringe-like device and sucked the clot out, reopening the vessel in just 15 minutes. “It was like watching the pneumatic tube at the bank drive-in,” said Dr. Lee.  “Whoosh!  It was gone.”

“Courtney is a lucky young woman for many reasons,” says Alhajeri. “The doctor in the Russell County Hospital ER had the foresight to call our stroke team despite Courtney’s lack of major symptoms.  The TPA they gave her delayed her decline and bought us some time to perform the thrombectomy.”

“She is also fortunate that UK has the resources to treat her. The next closest center that might have been able to treat her was an additional 90 minutes away.  She didn’t have 90 minutes to spare.”

Since her illness has an 80-90 percent mortality rate, the mere fact that Courtney is alive today is a wonder.  But the best part?

“The very few who survive this devastating event typically are left with substantial impairments, such as vision problems, the inability to speak or swallow, or complete paralysis,” says Lee. “But Courtney’s only residual deficit is some double vision on her far left gaze. We’re truly thrilled with her outcome.”

After Courtney’s close call, the Wilsons brought son Jaylynn into their family through adoption.

And now, just three years later, Courtney has yet another reason to feel blessed. On Sept. 1 of this year, she gave birth to a baby girl, who came into the world measuring 6 pounds, 11 ounces and  19.5 inches long.

Her name? Carlee.

“We are forever grateful for Dr. Lee and her medical staff,” wrote Courtney and her husband, Paul. “We wanted to honor her by naming our daughter Carlee.”


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A certain form of Alzheimer's immunotherapy has been unsuccessful, and researchers didn't know why. But UK Sanders-Brown research might be able to tell us.

Sanders-Brown research hints at underlying cause for Alzheimer’s drug trial failures

Because Alzheimer’s disease is the leading cause of dementia, many people use the two terms interchangeably. But inadequate blood flow to the brain due to strokes or ministrokes, called minifarcts, is a hallmark of a disease called Vascular Cognitive Impairment and Dementia (VCID). VCID is the second most common cause of dementia, and the two are not mutually exclusive – researchers estimate that 40-60% of Alzheimer’s disease patients also have VCID.

VCID may be making an Alzheimer’s treatment ineffective

A paper recently published in the Journal of Neuroscience by Donna Wilcock, PhD, of the University of Kentucky Sanders-Brown Center on Aging, reports that a certain form of immunotherapy targeted to Alzheimer’s patients may be ineffective when that patient also has VCID.

“These findings are important in that they provide a possible explanation for why clinical trials of anti-Aβ immunotherapy for Alzheimer’s disease have been historically unsuccessful,” Wilcock said. “If up to 40 percent of people with Alzheimer’s also have VCID, treatment candidates that target only the Alzheimer’s physiology won’t be effective in those patients. It’s like treating only half the disease.”

How the immunotherapy works

Most researchers agree that the formation of brain plaques containing amyloid β (Aβ) peptides is an initial step in the development of Alzheimer’s disease, which has led to a race to identify and test treatments that reduce the levels of these plaques. Anti-Aβ immunotherapy, which uses antibodies against Aβ to clear it from the brain, has been a leading approach.

While these drugs showed promise in animal studies, clinical trials have failed to show similar benefits in human patients.

“There has been one failure after another in clinical trials, which has been really disheartening for the scientific community and for patients, Wilcock said. “My work might shed some early light on why they failed and eventually open the door for a combination treatment for VCID and Alzheimer’s.”

Searching for new possibilities 

Without a suitable animal model, testing this hypothesis would not have been possible. Fortunately, Wilcock and her research team had already developed an innovative model of combined Alzheimer’s and VCID. Using this mouse model, together with its parent model of Alzheimer’s without VCID, Wilcock evaluated the ability of an anti-Aβ antibody to enhance cognitive capabilities in both models. While Aβ levels were reduced in both groups, cognitive function was not improved in the groups with combined Alzheimer’s and VCID.

“The failure of anti-Aβ immunotherapy in the mixed Alzheimer’s-VCID model suggests that both disease processes have to be treated to have a successful outcome,” Wilcock said. “The missing link has been that our animal models usually possess the hallmarks of only one disease, which has led to failure of successful translation to clinic.”

By developing a model that more accurately reflects the brain changes we see in the human brain with dementia, we can better develop our treatment approaches and increase our chances of successful translation. Our next step is to add a treatment for VCID on top of the Aβ immunotherapy to try to overcome the inability to produce a meaningful improvement in learning and memory.”

Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award numbers F31NS092202 and 1RO1NS079637. This content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.


Next Steps

Dr. Kyrkanides, second from left, and his research team.

UK Dentistry dean aims for excellence through research

Twenty-five years ago, Dr. Stephanos Kyrkanides began a research project during his orthodontic residency studying children born with cleft lip and palate. It was this project that sparked the realization for him that research is crucial and has been a driving force throughout his career.

“It was through the cleft lip/palate project and others that I came to the realization that research is the main engine in producing new, original knowledge so we can advance our science, both in medicine and dentistry, in order to improve patient care,” Kyrkanides said.

Watch a video featuring Dr. Kyrkanides below.

Dean of the UK College of Dentistry, Kyrkanides is both a dentist and neuroscientist. He came to UK last year from Stony Brook University in New York, one of the leading public research institutions in the country.

Kyrkanides has many accomplishments including inventing Natural Enamel, a new biomaterial for use in restorative dentistry. He also collaborated with researchers from across the country, including Dr. Sabine M. Brouxhon from the UK College of Medicine Department of  Surgery, to develop a novel cancer drug while at the State University of New York that is licensed by COI Pharmaceuticals Inc., an Avalon Ventures/GlaxoSmithKline consortium.

Currently, Kyrkanides and his team are dedicated to researching regenerative dentistry and are working to prove that dental enamel and fillings can be made out of patients’ cells. This would eliminate having to use plastic, metal or glass for dental reconstruction.

Kyrkanides said being a researcher at UK has been a rewarding experience.

“Having joined UK from the east coast, I have realized that UK, as a campus, is the place to be as a researcher,” he said. “It offers many collaborative opportunities through its many centers, such as the Markey Cancer Center, an NCI designated center … the Sanders-Brown Center on Aging, the Center for Oral Health and many others. There’s probably no other place where all this activity happens on one campus.”

Kyrkanides has excelled during his career and continues to accomplish more goals at UK. He believes that he is in a great atmosphere for research and has big plans to further transform the school of dentistry.

“As dean of the college, I’m committed in leading UK Dentistry into its full potential,” he said. “What I realized from the beginning, is that we have a group of faculty, staff and students that are very talented, very motivated and willing to work hard to join me into making UK Dentistry the No. 1 dental school in the country, maybe in the globe.”


Next steps:

  • Learn more about UK Dentistry, which offers expert comprehensive dental treatment for the entire family, including general, orthodontic and oral surgery services.
  • Visit UK Dentistry on Facebook to stay up to date on community events, programs, treatments, research, new physicians and more.
Making the Rounds with Dr. Gregory Jicha.

Dr. Gregory Jicha dishes on his past life as a chef

Making the RoundsIntroducing Making the Rounds, a new Q&A series where you’ll get to know the providers at UK HealthCare and what they’re like outside the lab and clinic. For our first entry, we spoke with Dr. Gregory Jicha, a clinician and researcher at the UK Sanders-Brown Center on Aging.

Dr. Gregory Jicha

Dr. Gregory Jicha

What was the last movie/book you saw/read?

I never read books because I read medical journals, and that requires all of my time. I have not read a book for fun since I was an undergraduate. Now, what’s the last movie that I watched? I watched “Harry Potter and the Deathly Hallows” with my children.

Do you have an ideal vacation destination?

Yes, any tropical island with palm trees that have coconuts. You have to pick up the fallen coconuts to knock the ones that are ripe – that’s how the locals do it!

Do you have a favorite type of exercise or fitness?

Nope. I see patients from 8 in the morning until 5 every night, whether it’s in clinic or in the research enterprise. So all of my papers and my grants have to be written after hours and on the weekends. With that being said, it’s a passion. Although, by God, I need one of those tropical vacations.

Do you have a favorite type of food that you like to eat?

I like all types of food. As a matter of fact, in a past life, I was a chef. I worked in a quaint restaurant – one of those historic landmarks – the Blacksmith’s Tavern up in Connecticut, built in 1771. It was French continental cuisine.

I also worked with a Greek family opening up a whole series of restaurants throughout Connecticut, Massachusetts and Rhode Island, which I really enjoyed. You got to write the menus and not just come up with daily specials.

Do you like to cook at home?

Every now and then I have a break, and I say, “I just cannot do anymore work.” Then I ask my wife, “May I cook today?” And she says, “Oh, god.” Because I still have this habit, you know, when you work in restaurants, and especially when you’re the chef, you don’t clean up anything. You cut on the cutting board and all the scrap you just sweep with your towel! All over to the side, all on the floor, and then people sweep up after you.

So, I still cook at home that way, and my wife knows if I’m cooking for the day it’s going to be wonderful food, but she’s going to be spending two or three days cleaning up.


Check out this video to see Dr. Jicha discuss how he helps patients as both a clinician and a researcher.


Next Steps

Ron and Carolyn Borkowski visit with the UK Sanders-Brown Center team member Marie Smart.

UK Sanders-Brown Center receives $8.25 million for Alzheimer’s research

The UK Sanders-Brown Center on Aging Alzheimer’s Disease Center (ADC) has been awarded an $8.25 million, five-year grant from the National Institutes of Health (NIH) to continue and further research and clinical initiatives geared toward treating Alzheimer’s disease.

Currently, only 30 designated Alzheimer’s Disease Centers exist in the U.S. In 1985, Sanders-Brown was among the first 10 ADCs funded by the NIH and has been continuously funded since the designation was launched.

The power of advanced medicine

“The Sanders-Brown Center on Aging is one of UK’s outstanding centers, and continued federal funding from the National Institutes of Health is yet another acknowledgement of its excellence,” said UK President Dr. Eli Capilouto. “The University of Kentucky is proud to play a leading role in the international effort to discover solutions for what is arguably one of society’s greatest medical mysteries and challenges.”

Capilouto noted that the University of Kentucky is one of an elite group of 21 universities in the nation to house a trifecta of nationally accredited research institutions, including a National Cancer Institute-designated cancer research center (Markey Cancer Center), an NIH-funded Center for Clinical and Translational Science (CCTS) and the National Institute on Aging-funded Alzheimer’s research center (Sanders-Brown Center on Aging).

More than just research

U.S. Rep. Andy Barr said the grant means much more than dollars and cents. “By 2050, Alzheimer’s diagnoses are expected to triple, with an associated cost of more than $1 trillion,” Barr said. “We cannot stand by and watch people suffer both financially and emotionally, and this grant rightfully continues a legacy that has benefited not only the citizens of Lexington and the Commonwealth but also people around the world.”

According to Linda Van Eldik, PhD, director of Sanders-Brown, the center is a leader in the detection of early neuropathological changes in the brain associated with Alzheimer’s and other age-related dementias, made possible in part by a large cohort of more than 800 volunteers – both healthy and cognitively impaired – in the Sanders-Brown Longitudinal Study, which generates significant amounts of data about how healthy brain aging occurs and when and why some people develop Alzheimer’s.

However, she says, research is just one component of the center’s efforts.

“We often say Alzheimer’s is a family disease.  It affects the patient primarily, but it is a devastating financial and emotional burden for family and caregivers as well,” she said. “Sanders-Brown offers outreach, education and support to help patients and their families get the help they need to lead active and engaged lives.”

“We’re honored that the NIH continues to recognize the caliber and scope of our work with this grant,” Van Eldik said.

‘Sanders-Brown is a jewel in our own backyard’

Ron and Carolyn Borkowski of Lexington are both givers to and beneficiaries of Sanders-Brown’s work. Carolyn, who was diagnosed with Alzheimer’s in 2012, is a patient, and both she and Ron participate in the Longitudinal Study and will donate their brains to Sanders-Brown upon their deaths.

“I’d hate to see where we’d be without Sanders-Brown,” Ron said. “The doctors and the staff are not just with you – they are truly for you.”

“Sanders-Brown is a jewel in our own backyard.”

UK initiated its aging program in 1963. With a grant from the Eleanor and John Y. Brown Jr. Foundation in 1972, the construction of the current Sanders-Brown Research Building was begun and, with additional funding from the state, a program in biomedical research was implemented. In 1979, under the direction of the late Dr. William Markesbery, Sanders-Brown emerged as a national leader in efforts to improve the quality of life for the elderly through research and education.

Treatment options for patients with drug-resistant epilepsy

Treatments available for drug-resistant epilepsy

Written by Dr. Frank Gilliam, director of the Epilepsy Center at the Kentucky Neuroscience Institute at the University of Kentucky. 

Dr. Frank Gilliam

Dr. Frank Gilliam

One in 26 people will develop epilepsy – a chronic disease characterized by unpredictable seizures — in their lifetime.

A seizure is a sudden surge of electrical activity in the brain that can temporarily change how a person thinks or behaves. Seizures can be scary for both the patient and the people around them, since patients can lose awareness or even become unconscious, twitch or spasm, babble, have blurry or no vision, experience difficulty breathing, and/or a host of other symptoms.

Epilepsy has numerous physical and emotional costs. People with epilepsy have problems keeping up in school or at work, can be depressed and/or socially isolated, can suffer physical injury during a seizure, and can even die from a seizure. They may not be allowed to drive, play sports or have other restrictions that affect their professional or personal lives.

It’s important to remember that not all seizures are epilepsy. A person is diagnosed with epilepsy if they have one or more seizures that were not caused by some known and reversible medical condition such as diabetes. People can develop seizures after a brain injury (like a car accident or getting hit in the head with a baseball), a stroke, or because of an infection or a brain tumor. Sometimes there is a family history of seizures, but often the cause is unknown.

If you suspect you have had a seizure, you should see your family doctor or a neurologist for an evaluation. That is likely to include a detailed conversation about what happened during your seizure, medications you are taking, preexisting illnesses or injuries, family history and more. The doctor is also likely to order blood tests that might identify treatable medical disorders, an EEG, which measures brain waves and looks for abnormalities that point to epilepsy or other neurological disorders, and possibly also a CAT scan or MRI to look for abnormal areas of the brain.

There is no cure for epilepsy, but two-thirds of all people with epilepsy are able to control their seizures with medications. The remaining one-third have what’s called “drug-resistant” or “refractory” epilepsy. In those cases, patients may be able to find relief through surgery or through devices that can help override the abnormal electrical impulses in the brain.

In the U.S., there are more than 100,000 patients who are candidates for epilepsy surgery, and only about 2,000 people have the surgery every year. Patients don’t need to suffer from the physical and emotional effects of epilepsy for 10 or 20 years. If someone has uncontrolled epilepsy for more than a year, they should seek an opinion at an accredited epilepsy center.


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UK researcher leads International Epilepsy Cure Initiative

With the help of an $8.5 million grant, a UK researcher will lead an international team of scientists to pursue a cure for Lafora’s disease, a deadly neurodegenerative condition.

Lafora’s disease appears in patients during adolescence and causes severe epilepsy, loss of speech and muscle control, and dementia, eventually leading to death.

Matthew Gentry

Matthew Gentry

Under the guidance of University of Kentucky College of Medicine Professor Matthew Gentry, the five-year National Institutes of Health (NIH) grant establishes the International Epilepsy Cure Center based at the UK College of Medicine’s Department of Molecular Medicine and Biochemistry. The center represents a collaborative effort to advance translational research and improve the diagnosis and treatment of Lafora’s disease, with the ultimate goal of finding a cure.

The center, which is funded by an NIH Program Project Grant, provides a framework for uniting multidisciplinary researchers in conducting important research exploring the molecular mechanisms that underlie Lafora’s disease.

The team comprises distinguished basic science researchers from around the world, including Gentry, a professor of molecular and cellular biochemistry at UK, Joan Guinovart in Barcelona, Spain; Berge Minassian of the Hospital for Sick Kids in Toronto, Canada; Peter Roach of Indiana University; and Jose Serratosa of Autonoma University of Madrid in Madrid, Spain.

“It is an amazing opportunity to lead this group of distinguished scientists from around the world towards such an important goal,” Gentry said. “Each of us have worked independently for more than a decade on Lafora’s disease and this grant now brings us together to develop the first cure for an epilepsy.”

Learn more about the Lafora’s disease and Gentry’s efforts to find a cure.

Blood thinners

Are the new blood thinner options right for you?

Written by George Davis, anticoagulation program pharmacist coordinator with UK HealthCare.

George Davis

George Davis

Blood thinners are commonly prescribed for prevention of stroke in patients with certain heart conditions or for treatment of blood clots. These drugs, also known as anticoagulants, can save lives for patients who have blood clots or are at high risk for them. However, the arrival of a new class of anticoagulants creates a confusing array of choices. Here are some basics to help you decide which medication is right for you.

All blood thinners cause an increased risk of bleeding – sometimes life-threatening – but that shouldn’t prevent doctors from prescribing it or patients from taking it. One-third of U.S. patients with atrial fibrillation, or afib, who need anticoagulation aren’t receiving it, according to a recently published major study.

With a 50-year track record, warfarin is the traditional option. For patients well managed on warfarin, it can be safe and effective. However, warfarin requires some trial and error to determine the most effective dose while minimizing bleeding hazards, initially requiring frequent (every few days to weekly) lab monitoring (called INR) and can be affected by factors like age, diet and other medications you are taking.

In the last five years, there have been four direct oral anticoagulants (DOACs) approved in the United States: apixaban, dabigatran, edoxaban and rivaroxaban. When compared to warfarin in major clinical trials, these DOACs were equally effective and demonstrated a lower incidence of major bleeding. DOACs have other advantages, including no need for routine lab monitoring, fewer drug and diet interactions, and more predictable dosing.

But DOACs still can cause bleeding and patients should routinely see a health care provider to check for compliance, drug interactions, and any changes in kidney or liver function, since DOACs can have some associated adverse effects. Additionally, DOACs are more expensive than warfarin, although manufacturers offer assistance programs to qualified patients that can help defray costs.

If a patient on the DOAC dabigatran experiences severe bleeding, a recently approved drug can help reverse that, and an antidote for the other three DOACs may be available soon.

While DOACs are effective, patients already taking warfarin shouldn’t automatically switch to a DOAC, especially if they are tolerating warfarin well.

Now more than ever, if your doctor wants you to begin taking a blood thinner, discussing the different options available is important. This discussion can educate you about the benefits of preventing blood clots versus risk of bleeding.

As always, don’t ever stop or make changes to any medication you’ve been prescribed without telling your health care provider.

George Davis is the anticoagulation program pharmacist coordinator with UK HealthCare Pharmacy Services and the UK Gill Heart Institute, and associate adjunct professor at the University of Kentucky College of Pharmacy.


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