Early Versus Delayed Initiation of Pharmacological Venous Thromboembolism Prophylaxis After an Intracranial Hemorrhage.

Background: Intracranial hemorrhage (ICH) accounts for up to 20% of all strokes with and carries an approximate 50% 30-day mortality. The risk of venous thromboembolism (VTE) is markedly higher in patients with ICH compared with ischemic strokes, but the optimal time to initiate pharmacological prophylaxis is ill-defined.

Design: Retrospective analysis.

Evaluation of venous thromboembolism prophylaxis in patients with chronic liver disease.

Background: The incidence of venous thromboembolism (VTE) in chronic liver disease (CLD) patients has been reported to be 0.5% to 6.3%.

Phenytoin-rifampin drug interaction in a hypoalbuminemic, renal failure patient: a complex clinical case.

Phenytoin, a commonly used antiepileptic, is difficult to dose optimally due to its narrow therapeutic window, nonlinear pharmacokinetics, extensive protein binding, and participation in clinically significant drug interactions. Although clinicians are aware of the interaction with two widely used antituberculosis agents, rifampin and isoniazid, few reports have described the implications for managing phenytoin dosing in this situation. To our knowledge, only two reports of the clinical experience with this interaction have been published, and only one of these reports involved the addition of isoniazid.

Treatment of warfarin-related intracranial hemorrhage: a comparison of prothrombin complex concentrate and recombinant activated factor VII.

Objective: Warfarin-related intracranial hemorrhage (ICH) is a devastating complication of warfarin therapy. Several studies have demonstrated successful correction of the international normalized ratio (INR) using prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa). To our knowledge, no study has directly compared these agents for treatment of warfarin-related ICH.

Early vs delayed enteral nutrition in critically ill medical patients.

This study was conducted to identify current practice in provision of enteral nutrition (EN) and to determine effects of early enteral nutrition (EEN) on length of stay in the medical intensive care unit (ICU). In this prospective, observational study, medical ICU patients were evaluated to determine their candidacy for EEN. If patients were candidates for EN and expected to remain nothing-by-mouth for 48 hours, they were classified as receiving EEN (within 24 hours of admission) or delayed EN.

Unrecognized valproic acid intoxication.

We report the case of a patient with schizophrenia who presented to the emergency department (ED) with a mental status change. He was initially treated for nonconvulsive seizures until a valproic acid (VPA) serum concentration test was performed and indicated acute intoxication. To report a case of acute intoxication with VPA that was unrecognized and treated as nonconvulsive seizure.

Intracerebral hemorrhage secondary to a warfarin-metronidazole interaction.

Background: It has been >25 years since the interaction between warfarin and metronidazole was last reported in the literature. The current case report represents the first documentation of this interaction associated with intracerebral hemorrhage.

Case Summary: We present a case of a 78-year-old white woman started on metronidazole (250 mg every 8 hours for 5 days) and levofloxacin (500 mg QD for 6 days) for an upper respiratory tract infection after visiting a walk-in clinic.