Quick Reference Guide Clinical Recommendations

11 August 2024

Quick Reference Guide: Clinical Recommendations

1. INR Target for Stroke Prevention in Atrial Fibrillation (Afib):

  • INR Target: The recommended International Normalized Ratio (INR) target for preventing ischemic stroke in patients with atrial fibrillation is 2.0 to 3.0. This range helps to optimize anticoagulation therapy, balancing the risk of stroke against the risk of bleeding.

2. Hepatitis B (HBV) Vaccine Recommendations:

  • Children:
    • The current recommendations include administering the three-dose HBV series starting at birth or at age 11 to 12 years if not previously vaccinated.
    • Preterm infants should be at least 1 month old before starting the HBV series.
  • High-Risk Groups:
    • IV drug users
    • Infants born to HbsAg-positive mothers
    • Hemodialysis patients
    • Sexually active individuals with multiple partners
    • Incarcerated individuals
    • International travelers
    • Household and sexual contacts of hepatitis B carriers
    • People getting tattoos or sharing personal items (razors, toothbrushes, body-piercing jewelry)
    • Health-care workers and daycare staff
    • Individuals with diabetes

3. Tuberculin (TB) Screening Recommendations:

  • Targeted Screening:
    • Patients with compromised immune systems (e.g., HIV-positive, undergoing immunosuppressive therapy, or prolonged corticosteroid therapy).
    • Close contacts of newly diagnosed TB patients.
    • Injection drug users known to be HIV seronegative.
    • Foreign-born individuals from high-prevalence countries.
    • Medically underserved low-income populations.
    • Residents and staff of long-term care facilities or prisons.
    • Routine screening for healthcare providers is recommended.

4. Ultimate Goals of Therapy for HIV:

  • Primary Objectives:
    • Reduce HIV-associated morbidity and prolong the duration and quality of survival.
    • Restore and preserve immunological function.
    • Achieve maximal and durable suppression of plasma HIV viral load (goal: HIV RNA less than 50 copies/mL).
    • Prevent HIV transmission.
  • Additional Goals:
    • Improve quality of life.
    • Prolong survival.
    • Reduce HIV-related morbidity.
    • Reduce transmissibility of HIV.
    • Prevent vertical (mother-to-child) HIV transmission.

5. T-Score and Management in Osteoporosis:

  • T-Score Interpretation:
    • T-Scores < -2.5: These patients are the major focus of prefracture treatment.
    • T-Scores Between -1.0 and -2.5: Patients with these scores, along with other risk factors that increase the 10-year fracture risk to more than 20%, should also be considered for drug interventions.