Direct Oral Anticoagulants for the Treatment of Venous Thromboembolism in Obesity.

Direct oral anticoagulants (DOACs) are known to have similar efficacy with a decreased risk of bleeding when compared to warfarin for the treatment of venous thromboembolism (VTE). In patients with obesity, there are limited data regarding the safety and efficacy of DOACs. Despite concerns for both under- and over-dosing patients with extremes of body weight, there are no dose adjustment recommendations in the package inserts for any of the DOACs.

SGLT2 Inhibitors to Slow Chronic Kidney Disease Progression: A Review.

Purpose: One in seven Americans is at risk for chronic kidney disease (CKD). For decades, the only treatment proven to slow progression of CKD was the use of renin-angiotensin-aldosterone system inhibitors. Based on promising secondary kidney outcomes in the cardiovascular outcome trials with sodium-glucose co-transporter-2 inhibitors, kidney outcome trials in patients with CKD were published for canagliflozin, dapagliflozin, and empagliflozin.

If you don't test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria.

Objective: Screening for asymptomatic bacteriuria (ASB) is not recommended outside of patients undergoing invasive urological procedures and during pregnancy. Despite national guidelines recommending against screening for ASB, this practice is prevalent. We present outcomes from a quality-improvement intervention targeting patients undergoing cardiac artery bypass grafting surgery (CABG) at Massachusetts General Hospital, a tertiary-care hospital in Boston, Massachusetts, where preoperative testing checklists were modified to remove routine urinalysis and urine culture.

Dual Antiplatelet Therapy After an Acute Nonminor Stroke.

Background: In select patients with minor ischemic stroke, dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel is recommended if initiated early and continued for 21 to 90 days. Dual antiplatelet therapy use, in a broader population, has shown to increase the risk of bleeding without an increased antithrombotic benefit. An ongoing area of uncertainty is whether DAPT would benefit the nonminor stroke population when continued for 21 to 90 days.

Safety of Nonvitamin K Antagonists Compared with Warfarin in Patients with Atrial Fibrillation and End-Stage Kidney Disease.

Objectives: This study evaluated the occurrence of major bleeding following the initiation of oral anticoagulation therapy in patients with end-stage kidney disease (ESKD) in a community teaching hospital.

Methods: This was a single-center retrospective study that enrolled patients admitted to the study hospital with ESKD and who received oral anticoagulation (warfarin or nonvitamin K oral antagonists [NOACs]). The primary endpoint was the occurrence of major bleeding at any time while taking oral anticoagulation.

A Review of Direct Oral Anticoagulants in Patients With Stage 5 or End-Stage Kidney Disease.

Objective: To evaluate the role of oral anticoagulation in patients with stage 5 chronic kidney disease (CKD-5) or end-stage kidney disease (ESKD).

Data Sources: A literature search of PubMed (January 2000 to July 1, 2021), the Cochrane Library, and Google Scholar databases (through April 1, 2021) was performed with keywords (direct-acting oral anticoagulant) OR or OR OR OR AND combined with (AF) or (VTE) OR OR .

Study Selection And Data Extraction: Case-control, cohort, and randomized controlled trials comparing DOACs to an active control for AF or VTE in patients with CKD-5 or ESKD and reporting outcomes of stroke, recurrent thromboembolism, or major bleeding were included.

Impact of SGLT2 inhibitors on cardiovascular outcomes in patients with heart failure with reduced ejection fraction.

Heart failure (HF) impacts more than 6 million Americans with an annual mortality rate approaching 22%. Along with optimizing guideline-directed management and therapy (GDMT), the development of treatment options to improve mortality and morbidity in patients with HF with reduced ejection fraction (HFrEF) is paramount. Cardiovascular outcome trials in patients with type 2 diabetes have shown that sodium-glucose cotransporter-2 (SGLT2) inhibitors improve both cardiovascular (CV) and renal outcomes and have consistently reduced hospitalizations for HF in patients with and without a previous history of HF.

Efficacy and Safety of Nonvitamin K Oral Anticoagulants following Cardiac Valve Replacement.

Objective: To compare the efficacy and safety of nonvitamin K oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) following bioprosthetic cardiac valve replacement.

Methods: This was a retrospective analysis conducted at a community teaching hospital in the southeastern United States between August 2015 and August 2018. Patients 18 years of age and older who underwent cardiac valve replacement and were prescribed oral anticoagulation were screened for inclusion.

Frequency of β-Blocker Use Following Exacerbations of COPD in Patients with Compelling Indication for Use.

Objective: To assess the current use of β-blockers in patients with compelling indications for use, following the acute exacerbation of chronic obstructive pulmonary disease (COPD).

Methods: We performed a multicenter retrospective observational study using data from all of the patients admitted to five institutions for an acute exacerbation of COPD. Patients were included if they were admitted for an acute exacerbation of COPD and had a compelling indication for the use of a β-blocker, defined as previous myocardial infarction or heart failure with left ventricular ejection fraction ≤40%.

Timing of Anticoagulation in Atrial Fibrillation Status Post Cardioembolic Stroke.

Background: Anticoagulation is the mainstay of secondary stroke prevention in patients with atrial fibrillation; however, few studies have assessed the optimal timing for initiation of anticoagulation post cardioembolic stroke. In the 2 weeks following an acute cardioembolic stroke, the risk of recurrent stroke is as high as 8%, but this risk must be balanced against the risk of hemorrhagic transformation with early initiation of anticoagulation.

Purpose: This study described the time to initiation of anticoagulation and evaluated the in-hospital incidence of hemorrhagic and ischemic complications in 106 patients with atrial fibrillation post an acute cardioembolic stroke.

Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures.

Purpose Of Review: To summarize reports published since the 2013 American Society of Bone and Mineral Research Task Force Report on atypical femoral fractures (AFF).

Recent Findings: The absolute incidence of AFFs remains low. AFFs are primarily associated with prolonged bisphosphonate (BP) exposure, but have also been reported in unexposed patients and those receiving denosumab for osteoporosis and metastatic bone disease.

Robust Trabecular Microstructure in Type 2 Diabetes Revealed by Individual Trabecula Segmentation Analysis of HR-pQCT Images.

Type 2 diabetes (T2D) patients have an increased fracture risk, which may be partly explained by compromised bone microarchitecture within the cortical bone compartment. Data on trabecular bone parameters in T2D are contradictory. By high-resolution peripheral quantitative computed tomography (HR-pQCT), trabecular microarchitecture is preserved, yet larger trabecular holes are detected in T2D by MRI and DXA-based trabecular bone scores are abnormal.

Evaluation of weight-based vancomycin dosing for hospitalized hemodialysis patients.

Background: Current vancomycin dosing guidelines recommend targeting trough concentrations of 15-20 mg/L in complicated infections to avoid treatment failure and resistance. How to accomplish this in the intermittent hemodialysis (IHD) population has not been adequately described. A weight-based vancomycin dosing protocol for IHD patients was developed to provide standardization of vancomycin dosing for this patient population.

Daily life evidence of environment-incongruent emotion in schizophrenia.

Researchers have recently hypothesized that negative emotion in positive situations may be one mechanism for understanding emotion dysfunction in schizophrenia. Using ecological momentary assessment, we examined the relationship between emotion experience and environmental context in the daily lives of participants with and without schizophrenia. Participants with (n=47) and without schizophrenia (n=41) were provided a cellular telephone and called four times a day for one week.

Nebivolol for the treatment of heart failure.

PURPOSE. The pharmacology, pharmacokinetics, efficacy, safety, and place in therapy of nebivolol are reviewed. SUMMARY.

Survey of physician knowledge and counseling practices regarding acetaminophen.

Objective: To assess physician knowledge regarding acetaminophen dosing, toxicity, and recognition of acetaminophen-containing products and counseling practices when prescribing acetaminophen-containing medications.

Methods: Resident and faculty physicians at 1 internal medicine and 2 family medicine residency programs in Alabama were asked to participate in a voluntary survey. Participants completed a 7-item self-administered questionnaire.

Role of tissue plasminogen activator in acute ischemic stroke.

Objective: To evaluate the literature regarding the use of intravenous tissue plasminogen activator (tPA) in the treatment of acute ischemic stroke, focusing on the appropriate usage criteria and administration time window.

Data Sources: A PubMed and MEDLINE search was performed (1990-November 2010) using the key words alteplase, tissue plasminogen activator, thrombolytic, ischemic stroke, and cerebrovascular accident.

Study Selection And Data Extraction: Clinical trials published in English were evaluated and relevant primary literature evaluating the use of tPA in acute ischemic stroke was included.

A retrospective characterization of worsening renal function in patients with acute decompensated heart failure receiving nesiritide.

Unlabelled: Nesiritide is approved by Food and Drug Administration (FDA) for the treatment of patients with acute decompensated heart failure (ADHF) due its ability to rapidly reduce cardiac filling pressures and improve dyspnea. Numerous studies have shown that renal dysfunction is associated with unfavorable outcomes in patients with heart failure. In addition, there have been reports suggesting that nesiritide may adversely affect renal function and mortality.

Leuconostoc species-associated endocarditis.

Leuconostoc species are gram-positive cocci belonging to the Streptococcaceae family. The species were generally regarded as nonpathogenic and of little importance in clinical microbiology until several occurrences of Leuconostoc infections were reported in the literature. Unlike many gram-positive bacteria, Leuconostoc species commonly demonstrate high-level resistance to vancomycin, with preserved sensitivity to most other antibacterial agents.

Thrombocytopenia associated with intravenous ciprofloxacin.

A variety of disease states, disorders, hereditary conditions, environmental toxins, and drugs may cause thrombocytopenia. Fluoroquinolones, however, are not thought to be common offenders. We report the case of a 72-year-old woman who was receiving intravenous ciprofloxacin for a urinary tract infection and developed thrombocytopenia during her hospital stay.