Impact of Antihypertensive Drug Class on Outcomes in SPRINT.

Background: The primary objective of this analysis is to assess if greater exposure to any major antihypertensive drug class was associated with reduced primary composite outcome events in SPRINT (Systolic Blood Pressure Intervention Trial).

Methods: This is a secondary analysis of the SPRINT trial evaluating whether longitudinal, time varying exposure to any major antihypertensive drug class had any impact on primary outcome events, after adjusting for effects of randomization arm, time varying achieved systolic blood pressure, other drug class exposure, and baseline characteristics.

Results: Nine thousand two hundred fifty-two participants were included.

Decreased warfarin sensitivity among patients treated with elbasvir and grazoprevir for hepatitis C infection.

Purpose: We previously reported an interaction with warfarin anticoagulation when initiating treatment with direct-acting antiviral agents for hepatitis C infection. A decreased warfarin sensitivity led to subtherapeutic anticoagulation. To study this interaction further, we expanded our research to include patients treated with the combination of elbasvir and grazoprevir concurrent with warfarin anticoagulation and investigated changes in warfarin sensitivity during and after treatment.

Evaluation of a Potential Interaction Between New Regimens to Treat Hepatitis C and Warfarin.

Objective: New regimens to treat hepatitis C virus infection have expanded the eligible patient population to include more patients receiving concurrent warfarin. The primary objective of this study was to assess whether a drug interaction occurs when these regimens are added to warfarin therapy.

Methods: This was a retrospective cohort design using a nationwide database of the Veterans Affairs Health System.

Comparative dose response using the intravenous versus enteral route of administration for potassium replenishment.

Objective: To compare the change in potassium concentration (dose-response) using the intravenous versus enteral route for potassium replenishment.

Research Methodology/design: Cross-sectional analysis of individual potassium chloride doses with resulting changes in plasma potassium concentrations in intensive care patients. Potassium chloride was administered according to potassium replenishment protocols.

Comparison of equations with estimate renal function to predict serum vancomycin concentration in patients with spinal cord injury--does the use of cystatin C improve accuracy?

Background: Vancomycin dose selection is challenging in the spinal cord injury (SCI) population because of the difficulty in accurately estimating the renal function. Creatinine-based equations have been shown to be unreliable in this patient population. Adjusted equations designed for patients with SCI have not been well studied.

Unnecessary antimicrobial use in patients with current or recent Clostridium difficile infection.

Objective: To determine the fraction of unnecessary antimicrobial use among patients with current and/or recent Clostridium difficile infection (CDI).

Design: Retrospective review from January 2004 through December 2006.

Setting: Minneapolis Veterans Affairs Medical Center (MVAMC).

Enoxaparin outcomes in patients with moderate renal impairment.

Background: Enoxaparin sodium has predictable pharmacokinetics that allow for simplified dosing without laboratory monitoring. Reliance on renal function for excretion may lead to accumulation of enoxaparin in patients with moderate renal impairment. However, there is no dose adjustment recommended for these patients.

Antimicrobial use and risk for recurrent Clostridium difficile infection.

Background: Although antimicrobial use during and immediately after Clostridium difficile infection (CDI) is discouraged, the frequency and consequences of such use are poorly defined. We sought to determine the frequency of non-CDI antimicrobial therapy during and after treatment for CDI, and the association of such therapy with recurrent disease.

Methods: Retrospective review of all CDI cases at a Veterans Affairs medical center from 2004-2006.

Treatment of non-life-threatening methicillin-resistant Staphylococcus aureus infections with alternative antimicrobial agents: a 2-year retrospective review.

The emergence of methicillin-resistant Staphylococcus aureus (MRSA) infections has created a need for additional antimicrobial options. Patients at the Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, who received alternative (nonvancomycin, nonlinezolid) therapy for MRSA infections from January 2004 to December 2005 were identified retrospectively, with sulfamethoxazole/trimethoprim, clindamycin, tetracyclines, and fluoroquinolones assessed as alternative agents. Medical records were reviewed to determine therapeutic outcome and drug tolerance.

Symptom-driven lorazepam protocol for treatment of severe alcohol withdrawal delirium in the intensive care unit.

Study Objective: To compare outcomes of treating alcohol withdrawal delirium (AWD) with a symptom-driven benzodiazepine protocol versus nonprotocol benzodiazepine infusions in the intensive care unit (ICU).

Design: Retrospective observational study of a quality improvement project.

Setting: Medical intensive care unit at a Veterans Affairs medical center.

Comparison of plasma concentrations for two amiodarone products.

Background: A generic formulation of amiodarone was recently approved by the Food and Drug Administration based on single-dose equivalence data. Because amiodarone has complex pharmacokinetic properties, a narrow therapeutic range, and a significant adverse effect profile, concern about equivalency persists.

Objective: To compare steady-state plasma concentrations of the brand-name reference product Cordarone with the AB-rated generic formulation, Pacerone, in patients exposed to both products.