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Dive into the research topics where Marta A. Miyares is active.

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Featured researches published by Marta A. Miyares.


American Journal of Health-system Pharmacy | 2012

Newer oral anticoagulants: A review of laboratory monitoring options and reversal agents in the hemorrhagic patient

Marta A. Miyares; Kyle A. Davis

PURPOSE Available evidence on laboratory monitoring of coagulation assays and reversal strategies for the management of hemorrhagic events associated with the newer anticoagulants is reviewed. SUMMARY While there are no published studies with dabigatran and prothrombinase-induced clotting time (PiCT) and no chromogenic assays available to measure the anticoagulant effects, thrombin time and activated partial thromboplastin time (aPTT ) may be used to detect the presence of dabigatran. Although ecarin clotting time is sensitive to elevated concentrations of dabigatran, only a small fraction of institutions have access to this assay. Rivaroxaban and apixaban prolong prothrombin time, dilute prothrombin time, aPTT, Heptest results, and PiCT to varying degrees, having the most- pronounced effects at higher concentrations. In contrast, the chromogenic antifactor Xa assay proved to be sensitive to lower amounts of rivaroxaban and apixaban with less variability. Despite the expectations with these newer anticoagulants, the associated risk of bleeding is significant, and there are insufficient data depicting treatment options in emergency situations. Until four-factor prothrombin complex concentrates (PCCs) become available in the United States, the obtainable options are activated PCC, three-factor PCCs, and recombinant factor VIIa. CONCLUSION Although there is currently no gold standard of measurement for any of the newer anticoagulants, the published literature enables practitioners to evaluate the efficacy and sensitivity of a majority of these assays. Prohemostatic agents can be used in instances of severe, life-threatening hemorrhagic complications.


American Journal of Geriatric Pharmacotherapy | 2012

Clinical challenges in a patient with dabigatran-induced fatal hemorrhage.

Ennie Cano; Marta A. Miyares

OBJECTIVE To report clinical challenges in managing dabigatran-induced bleeding. METHODS A 78-year-old woman came to the hospital with severe coagulopathy, respiratory failure, hypotension, and bleeding secondary to dabigatran therapy. At admission, creatinine clearance was 15 mL/min; prothrombin time, 147.5 seconds; activated partial thromboplastin time, >200 seconds; and international normalized ratio, 12.42. Medications taken at home included dabigatran, 150 mg BID. During the hospitalization, multiple blood product transfusions were given, vitamin K and prothrombin complex concentrate were administered, and dialysis was initiated in an attempt to achieve hemostasis. Despite multiple interventions, coagulopathy persisted (prothrombin time, 70.8 seconds; activated partial thromboplastin time, >200 seconds; and international normalized ratio, 6.05), with continued bleeding. On hospital day 5, the patient died. CONCLUSIONS According to the Naranjo probability scale, bleeding associated with dabigatran revealed a probable relationship. This fatal case illustrates our concern about the usefulness of currently recommended anticoagulation laboratory tests and of the efficacy of blood transfusion, dialysis, and prothrombin complex concentrate in managing life-threatening bleeding secondary to dabigatran. In addition, clinicians should be cognizant of the renal recommendations for the newer oral anticoagulant agents to prevent potentially catastrophic results.


Annals of Pharmacotherapy | 2011

Anacetrapib and Dalcetrapib: Two Novel Cholesteryl Ester Transfer Protein Inhibitors

Marta A. Miyares

Objective To evaluate the role of cholesteryl ester transfer protein (CETP) in the cholesterol transport system and review the pharmacology, pharmacokinetic properties, efficacy, and adverse effects of the CETP inhibitors, anacetrapib and dalcetrapib, for the treatment of dyslipidemia. Data Sources: A literature search was conducted in Ovid/MEDLINE (1950 to week 4 December 2010), PubMed/MEDLINE (up to December 2010). EMBASE (2000 to December 2010), and International Pharmaceutical Abstracts (1970 to December 2010) using the MeSH terms and key words anacetrapib, MK 0859, dalcetrapib, and JTT 705. The search was limited to publications in English. Study Selection And Data Extraction: Studies evaluating the pharmacology, pharmacokinetics, safety, and efficacy of anacetrapib and dalcetrapib for the treatment of dyslipidemia were included. Clinical reviews evaluating the characterization of CETP and its inhibition as a mechanism for reducing cardiovascular risk were also included. Data Synthesis: Anacetrapib and dalcetrapib represent a novel treatment option for patients who have dyslipidemia and low levels of high-density lipoprotein cholesterol (HDL-C). Anacetrapib and dalcetrapib increase HDL-C by inhibiting CETP-mediated transfer of cholesteryl ester and triglyceride. Studies evaluating the safety and efficacy of anacetrapib and dalcetrapib concluded that both agents safely and effectively augment HDL-C. Their mechanism of action, potential for significant raising of HDL-C, once-daily dosing regimen, and favorable lipid-altering effects when added to hydroxymethylglutaryl-CoA reductase inhibitors are key elements, Anacetrapib and dalcetrapib are well tolerated, with mild gastrointestinal complaints reported more than with placebo, Although another CETP inhibitor, torcetrapib, was withdrawn from clinical development secondary to increased morbidity and mortality, neither anacetrapib nor dalcetrapib has demonstrated the adverse off-target effects portrayed with torcetrapib. Conclusions: Inhibition of CETP by anacetrapib and dalcetrapib represents an encouraging development in the management of dyslipidemia, particularly in patients with low HDL-C levels. Results of future trials are much anticipated, as these will clarify the role of anacetrapib and dalcetrapib in reduction of cardiovascular disease.


Journal of Oncology Pharmacy Practice | 2015

Potential cost savings associated with dose rounding antineoplastic monoclonal agents

Sarah M. Francis; Alexander Heyliger; Marta A. Miyares; Marcos Viera

Purpose This study explored the potential financial benefits associated with dose rounding three costly cancer agents: bevacizumab, trastuzumab, and cetuximab. Methods Electronic chemotherapy health record software was queried to identify inpatient and outpatient use of bevacizumab, trastuzumab, and cetuximab. Available drug vial sizes were noted. Costs of actual doses prescribed were compared to theoretically reduced doses (5% and 10%) adjusted to the nearest vial size. Only doses resulting in a decrease in the number of vials qualified for dose rounding. New doses were analyzed for potential cost savings considering the percent-change from the original dose. All institutional review board procedures were followed. Results In all, 425 doses of bevacizumab, trastuzumab, and cetuximab were identified. At a 5% dose reduction, 51 doses (12%) qualified for dose rounding, translating to a potential cost savings of


American Journal of Health-system Pharmacy | 2015

Implementing a pharmacy resident run transition of care service for heart failure patients: Effect on readmission rates

Cristina M. Salas; Marta A. Miyares

60,648 (


Journal of Pharmacy Practice | 2015

Development of an Anticoagulation Stewardship Program at a Large Tertiary Care Academic Institution

Maria Padron; Marta A. Miyares

6,188,


American Journal of Health-system Pharmacy | 2014

Lomitapide: A novel agent for the treatment of homozygous familial hypercholesterolemia

Kyle A. Davis; Marta A. Miyares

52,640, and


Annals of Pharmacotherapy | 2015

Direct-Acting Oral Anticoagulants as Emerging Treatment Options for Heparin-Induced Thrombocytopenia

Marta A. Miyares; Kyle A. Davis

1,820, respectively). Although a 5% limit was set, the average change in dose did not exceed 2.5%. At a 10% dose reduction, 124 doses (29%) qualified for dose rounding, translating to a potential cost savings of


American Journal of Health-system Pharmacy | 2015

Dual antiplatelet therapy with clopidogrel and aspirin after ischemic stroke: A review of the evidence

Kyle A. Davis; Marta A. Miyares; Eric Dietrich

112,585 (


International Journal of Cardiology | 2016

A multidisciplinary team-based process improves outpatient anticoagulation quality with continuous-flow left-ventricular assist devices

Yara Kuyumjian; Marta A. Miyares; Jaime Leverock; Sandra Chaparro; William L. Baker; Douglas L. Jennings

26,520,

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Kyle A. Davis

Jackson Memorial Hospital

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Douglas L. Jennings

Nova Southeastern University

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Yara Kuyumjian

Jackson Memorial Hospital

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Alexander Heyliger

Nova Southeastern University

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Eliza Dollard

Jackson Memorial Hospital

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Ennie Cano

Jackson Memorial Hospital

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Joseph E Mazur

Medical University of South Carolina

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Kyle Davis

Indiana University Health

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