Impact of Apixaban Lead-In Therapy Duration After Parenteral Anticoagulation on Bleeding in Patients Treated for Venous Thromboembolism.

Venous thromboembolism (VTE) treatment with apixaban uses a higher 10 mg twice daily regimen for 7 days (lead-in therapy). But, in patients with initial parenteral anticoagulation treatment or those with higher bleeding risk, clinicians may not always adhere to the full 7-day lead-in duration. This retrospective cohort study included adult patients admitted to the Veterans Affairs Health care System from January 2011 to April 2022, who received at least 24 hours of parenteral anticoagulation followed by lead-in apixaban therapy for VTE.

The Effect of Vancomycin and Piperacillin-Tazobactam on Incidence of Acute Kidney Injury in Patients With Obesity.

Increasing evidence suggests that administration of combination vancomycin and piperacillin-tazobactam (VPT) increases the incidence of acute kidney injury (AKI) beyond that of vancomycin alone. But these investigations have not evaluated AKI risk specifically in an increasingly prevalent obese population in whom VPT pharmacokinetics are altered. : To evaluate AKI risk with VPT administration to patients with obesity.

The Risk of Major Bleeding With Apixaban Administration in Patients With Acute Kidney Injury.

Background: Apixaban is eliminated by the kidneys and in acute kidney injury (AKI) there is potential for an increase in apixaban exposure and bleeding events. In one instance, data have shown higher than normal bleed risk in patients with AKI, unless calibrated anti-factor Xa monitoring is used, which is not widely available.

Objective: To evaluate bleeding with apixaban administration to hospitalized patients with an AKI in an unmonitored real-world scenario.

The Association of Elevated Lactate With Multiple Vasopressor Administration in Patients With Septic Shock: A Retrospective Cohort Study.

In patients with septic shock and elevated lactate, there is limited evidence evaluating supplementary vasopressor use beyond vasopressin (AVP) and norepinephrine (NE). The purpose of this study is to describe vasopressor utilization and clinical outcomes based on lactate level. We conducted a retrospective study of patients with septic shock requiring NE.

Safety of Propofol When Used for Rapid Sequence Intubation in Septic Patients: A Multicenter Cohort Study.

Purpose: Septic patients are at risk for hypotension, and this risk may increase during rapid sequence intubation (RSI). Sedatives such as propofol must be used carefully due to its ability to reduce vascular sympathetic tone. Since the safety of propofol for RSI is not well described in sepsis, this was a study evaluating propofol and its effects on hemodynamics when used for RSI in a septic population.

The Effect of Prearrest Acid-Base Status on Response to Sodium Bicarbonate and Achievement of Return of Spontaneous Circulation.

Background: The efficacy of sodium bicarbonate (SB) administration during in-hospital cardiac arrest (IHCA) for treatment of acidosis is not well described. The available literature has only evaluated out-of-hospital arrest events in patients with suspected acidosis caused by prolonged arrest.

Objective: This study evaluated SB and its effects on return of spontaneous circulation (ROSC) in patients experiencing IHCA, based on presence of acidosis at baseline as determined by prearrest bicarbonate levels.

The effect of obesity on the rate of heparin-induced thrombocytopenia.

: Heparin-induced thrombocytopenia (HIT) occurs in patients receiving heparin-containing products due to the formation of platelet-activating antibodies to heparin and platelet factor 4. Diagnosis includes utilization of a scoring system known as the 4-T score, and HIT laboratory assays. Recently, obesity was identified as a potential factor associated with the development of HIT.

Impact of Admission Hypertension on Rates of Acute Kidney Injury in Intracerebral Hemorrhage Treated with Intensive Blood Pressure Control.

Background: Current guidelines recommend that rapid systolic blood pressure (SBP) lowering to 140 mmHg may be considered in intracerebral hemorrhage (ICH) patients regardless of initial SBP. However, limited safety data exist in patients presenting with varying degrees of severe hypertension. The purpose of this study was to determine whether there was an increased risk of acute kidney injury (AKI) based upon degree of presentation hypertension in ICH patients whose blood pressure was reduced intensively.

Continuous Infusion Antiepileptic Medications for Refractory Status Epilepticus: A Review for Nurses.

Status epilepticus requires treatment with emergent initial therapy with a benzodiazepine and urgent control therapy with an additional antiepileptic drug (AED) to terminate clinical and/or electrographic seizure activity. However, nearly one-third of patients will prove refractory to the aforementioned therapies and are prone to a higher degree of neuronal injury, resistance to pharmacotherapy, and death. Current guidelines for refractory status epilepticus (RSE) recommend initiating a continuous intravenous (CIV) anesthetic over bolus dosing with a different AED.

Antithrombotic Usage Patterns in the Era of New Oral Anticoagulant Options for Atrial Fibrillation.

Background: Appropriate treatment reduces the risk of stroke in patients with atrial fibrillation (AF). Despite the known benefits of warfarin, anticoagulation prescribing rates remain inadequate in high-risk patients. Over the last 6 years, 4 novel oral anticoagulants have been approved for use for stroke prophylaxis in non-valvular AF (NVAF), which may allow prescribers to tailor therapy for each NVAF patient.

Effects of propofol on vasopressor use in patients with sepsis and severe sepsis: A pilot study.

Purpose: Propofol is one of the most commonly used sedatives in the intensive care unit (ICU) despite its undesirable hypotensive effects. The purpose of this study was to determine the effects of continuous intravenous (CIV) propofol on vasopressor requirements in mechanically ventilated patients with sepsis.

Materials And Methods: A multicenter, retrospective, propensity-matched pilot study was conducted comparing patients with sepsis or severe sepsis who received CIV propofol for sedation to those who did not.

Consequences of treating false positive heparin-induced thrombocytopenia.

Identification of patients with heparin-induced thrombocytopenia is encumbered by false positive enzyme-linked immuno assay (ELISA) antibody results, therefore a serotonin release assay (SRA) is used for confirmation. Recently, several studies have demonstrated that increasing the optical density (OD) threshold (currently at 0.4) of the antibody test enhances the positive predictive value.

Assessing the Quality of Database Search Strategies Utilized by Meta-analyses That Evaluate Infectious Disease Drug Therapy.

Meta-analyses are increasingly influencing clinical practice, but significant methodological flaws have been reported. The purpose of this study was to evaluate the quality of search strategies utilized by anti-infective meta-analyses. The Embase database was searched for meta-analyses evaluating anti-infective drug therapy; 103 of 268 identified citations met inclusion criteria and were evaluated.

Post-translational glycosylation of target proteins implicate molecular mimicry in the pathogenesis of HTLV-1 associated neurological disease.

We hypothesized that molecular mimics between human T lymphotropic virus type 1 (HTLV-1) and human autoantigens were based upon post-translational modification of target proteins. Proteins purified from MT-2 (HTLV-1 infected) and Jurkat (HTLV-1 negative) cells were used for western blotting with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) IgG. In contrast to normal IgG, HAM/TSP IgG immunoreacted with proteins in MT-2 cells at 22-24 kDa, pI 8.

Strain differences in allele and expression levels of CD72 on B-lymphocytes from NOD, AKR, NON and C57BL/6 mice.

The B-lymphocyte marker CD72 has multiple alleles and serves crucial and nonredundant roles in B-cell development and activation. B-lymphocytes play an important role in development of autoimmune diabetes in NOD mice, therefore we examined the patterns of expression of CD72 and its alloantigens on splenic lymphocytes from 4-week-old NOD/LtJ mice. Comparisons of CD72 expression were made between NOD mice and three non-diabetic strains, NON/LtJ mice, C57BL/6J and AKR/J.