Bloodstream infections in prolonged use of axillary-placed, intra-aortic balloon-pump support: A single-center study.

Infections from prolonged use of axillary intra-aortic balloon pumps (IABPs) have not been well studied. Bloodstream infection (BSI) occurred in 13% of our patients; however, no difference in outcome was noted between those with BSI and those without. Further studies regarding protocol developments that minimize BSI risk are needed.

Vancomycin dosing in high-intensity continuous renal replacement therapy: A retrospective cohort study.

Introduction: An inverse relationship exists between vancomycin serum concentrations and the intensity of continuous renal replacement therapy (CRRT), reflected through the dialysate flow rate (DFR). There remains a lack of evidence to guide initial vancomycin dosing in the setting of high-intensity CRRT (i.e.

Direct oral to parenteral anticoagulant transitions: Role of factor Xa inhibitor-specific anti-Xa concentrations.

Objectives: The increasing use of oral factor Xa inhibitors (FXaI) has led to a growing interest in the clinical utility of laboratory monitoring to enhance safety and effectiveness. Particularly, the use of FXaI-specific anti-Xa concentrations has gained traction and been advocated for several indications, but limited studies have explored the role of anti-Xa concentrations in guiding inpatient transitions from oral to parenteral anticoagulants. Therefore, additional data on such approaches are warranted to help balance bleeding and thrombotic risks in the higher acuity inpatient setting.

Perioperative cangrelor in patients with recent percutaneous coronary intervention undergoing liver transplantation: A case series.

Background: Management of dual antiplatelet therapy (DAPT) in the perioperative setting is challenging, particularly in complex patient populations, such as those with underlying coagulopathy and/or recent percutaneous coronary interventions.

Methods: In this case series, we describe the perioperative use of cangrelor bridge therapy in two patients undergoing liver transplantation after recent coronary drug-eluting stent placement.

Outcomes: In both patient cases, cangrelor use as a P2Y12 bridge at a dose of 0.

Evaluation of Inhaled Alprostadil in Hospitalized Adult Patients.

Background: Intermittent inhaled alprostadil (iPGE) may be a viable alternative to inhaled nitric oxide or epoprostenol for management of right ventricular failure, pulmonary hypertension (pHTN) or acute respiratory distress syndrome (ARDS). However, limited evidence exists regarding iPGE use in adults, ideal dosing strategies, or optimal use cases.

Objective: To describe the clinical characteristics of patients receiving iPGE and identify specific sub-populations warranting further research.

Direct Oral to Parenteral Anticoagulants: Strategies for Inpatient Transition.

The primary objective of this study was to describe the impact on bleeding rates of 2 different strategies for transitioning from a direct oral anticoagulant (DOAC) to a parenteral anticoagulant: a delayed, clinically driven strategy versus the standard per-package-insert strategy. This was a single-center descriptive cohort study conducted at a large academic medical center. Included patients were 18 years or older, admitted as an inpatient, and had received at least 1 dose of a DOAC prior to initiation of therapeutic parenteral anticoagulation.

Second victim syndrome and the pharmacy learner.

This commentary describes the concept of second victim syndrome and its application to pharmacy learners and preceptors. Although there is published literature regarding implementation of second victim syndrome programs at an institutional level, there is limited guidance regarding the second victim syndrome in the context of a pharmacy training environment; however, there are known risk factors such as medication safety events, failure to rescue events, or overall lack of experience of a clinician. With a growing awareness of the mental health concerns of health care providers, this is a potential area for growth and skill development for pharmacists of all levels.

Use of Tissue Plasminogen Activator Alteplase for Suspected Impella Thrombosis.

Background: Impella devices are being increasingly used to manage cardiogenic shock. The incidence of thrombosis and hemolysis in patients on Impella support increases with longer durations of use, and the management of Impella thrombosis remains ill-defined.

Methods: In this case series, we describe our institutional use of tissue plasminogen activator (tPA) alteplase in the Impella purge solution (0.

Management of Anticoagulation with Impella® Percutaneous Ventricular Assist Devices and Review of New Literature.

Cardiogenic shock is a life-threatening condition that may occur secondary to a variety of cardiac conditions, and may require temporary support with percutaneous ventricular devices like the Impella®. Anticoagulation in patients with Impella® devices can often be complicated due to unpredictable purge flow rates, pre-existing coagulopathy, or heparin allergies. The purpose of this article is to discuss the various options for anticoagulation in the setting of Impella®.