A Single-Center, Retrospective Cohort Study Evaluating the Use of Probiotics for the Prevention of Hospital-Onset Infection in Hospitalized Patients Receiving Intravenous Antibiotics.

Background: Exposure to antimicrobials is a known risk factor for infection (CDI). Antimicrobials cause collateral damage by disrupting the natural intestinal microbiota allowing for to thrive and production of toxins. Probiotics could modulate the onset and course of CDI.

Alteplase for the treatment of midline catheter occlusions: a retrospective, single-cohort descriptive study.

Background: Despite the increasing popularity of midline catheters, data on the use of alteplase for restoring midline catheter patency is scarce.

Aims: This study aimed to evaluate off-label use of alteplase for midline catheter occlusions.

Method: Adults who received alteplase into a midline catheter between January 2015 and May 2018 within a multi-hospital health system were included in this study.

Hemodynamic Effects of Dexmedetomidine in Adults With Reduced Ejection Fraction Heart Failure.

Background: Dexmedetomidine (DEX) can cause hypotension complicating its use in critically ill patients with labile hemodynamics secondary to an underlying disease state such as heart failure. The aim of this study was to determine the effect of DEX on mean arterial pressure (MAP) in nonsurgical patients with heart failure and reduced ejection fraction (HFrEF).

Methods: This retrospective single-center cohort study evaluated patients who received DEX in the cardiac care and medical intensive care units at a large academic hospital.

Evaluation of the efficacy and safety of apixaban and rivaroxaban in cancer patients receiving concomitant active anti-neoplastic therapy at an outpatient cancer setting.

Introduction: Venous thromboembolism is a common complication among cancer patients with an estimated risk of 20%. American Society of Clinical Oncology guidelines recommend direct oral anticoagulants for long-term anticoagulation but caution the use of direct oral anticoagulants because of drug-drug interactions with antineoplastic therapies. The clinical impact of these drug-drug interactions is yet to be studied in clinical trials.

Evaluating Time to In-Hospital Venous Thromboembolism in Obese Patients.

Background: Currently, no consensus approach exists for optimal venous thromboembolism (VTE) prophylaxis in obese (BMI ≥30 kg/m) patients. Time to development of in-hospital VTE is not well studied.

Objective: This study evaluates time to in-hospital VTE in obese patients.

Direct oral anticoagulants versus aspirin for venous thromboembolism prophylaxis after orthopedic surgery.

Purpose: The risks of venous thromboembolism (VTE) and bleeding with direct oral anticoagulants (DOACs) and aspirin for thromboprophylaxis after orthopedic surgery were studied.

Methods: A single center, retrospective study was conducted to examine patients who underwent a major orthopedic surgery from 2011 to 2015. The primary endpoint evaluated was the net clinical outcome of bleeding and thrombosis rates between the DOAC and aspirin groups.

Comparison of Antifactor Xa and Activated Partial Thromboplastin Time Monitoring for Heparin Dosing in Vascular Surgery Patients: A Single-Center Retrospective Study.

Background: Vascular surgery patients often require anticoagulation with intravenous unfractionated heparin monitored through antifactor Xa (anti-Xa) levels or the activated partial thromboplastin time (aPTT). This study compares the 2 monitoring strategies in terms of major bleeding events in the vascular surgery population.

Methods: This was a single-center, retrospective study that included patients treated with a pharmacy-managed heparin protocol monitored by either anti-Xa or aPTT after vascular surgery.

Time to Occurrence Based on Risk Stratification of Hospital-Acquired Venous Thromboembolism: A Retrospective Observational Cohort Study.

Background: In-hospital venous thromboembolism (VTE) causes significant morbidity and mortality in hospitalized patients. The objective of our study is to determine the time to in-hospital VTE based on baseline risk stratification.

Methods: All adult patients admitted to a 900-bed academic tertiary referral hospital who developed a VTE during hospital admission from September 1, 2011, to June 30, 2015, were retrospectively analyzed.

Single-center, retrospective evaluation of safety and efficacy of direct oral anticoagulants versus low-molecular-weight heparin and vitamin K antagonist in patients with cancer.

Introduction: The safety and efficacy of direct oral anticoagulants in cancer patients is currently unclear. Low-molecular-weight heparin remains the standard of care for cancer patients with venous thromboembolism, with warfarin, a vitamin K antagonist, as an alternative. Clear recommendations do not exist for patients with both active cancer and non-valvular atrial fibrillation.

Prevalence of in-hospital nonsteroidal antiinflammatory drug exposure in patients with a primary diagnosis of heart failure.

Aim: To determine the prevalence of in-hospital nonsteroidal antiinflammatory drug (NSAID) exposure and associated outcomes in patients admitted with a primary diagnosis of heart failure.

Methods: We performed a propensity-matched cohort analysis of patients admitted to Houston Methodist Hospital System with a primary diagnosis of heart failure according to the International Classification of Diseases-9-Clinical Modification (ICD-9-CM) from January 1, 2011 to December 31, 2014.

Results: Of the 9742 patients admitted with a primary diagnosis of heart failure, 384 patients (3.

Discharge medication complexity and 30-day heart failure readmissions.

Background: Limited research exists regarding Medication Regimen Complexity Index (MRCI) and its utility in identifying patients at risk for hospital readmission.

Objective: This study evaluates the association between discharge MRCI and 30-day rehospitalization in patients with heart failure (HF) after discharge.

Methods: The study involved a retrospective, cohort study at a large tertiary teaching facility from the University HealthSystem Consortium.

In-hospital use of non-steroidal anti-inflammatory drugs in patients with heart failure in academic centers in the United States.

Background: Non-steroidal anti-inflammatory drugs are considered potentially harmful for patients with heart failure.

Objective: To determine the prevalence of in-hospital NSAID use, their type, associated diagnosis and impact in clinical outcomes among patients with a diagnosis of heart failure.

Methods: The University Health System Consortium Database was used to identify all first hospitalizations with an International Classification of Diseases-9 discharge diagnosis code of systolic heart failure as the primary diagnosis between January 1, 2011, and December 31st 2014.

Chemical shift assignments for S. cerevisiae Ubc13.

The ubiquitination pathway controls several human cellular processes, most notably protein degradation. Ubiquitin, a small signaling protein, is activated by the E1 activating enzyme, transferred to an E2 conjugating enzyme, and then attached to a target substrate through a process that can be facilitated by an E3 ligase enzyme. The enzymatic mechanism of ubiquitin transfer from the E2 conjugating enzyme onto substrate is not clear.

Evaluation and Pharmacokinetics of Treatment Dose Enoxaparin in Hospitalized Patients With Morbid Obesity.

Background: The pharmacokinetic properties of enoxaparin may lead to supratherapeutic antifactor Xa (anti-Xa) levels and increased bleeding when standard treatment doses are used in patients with morbid obesity.

Objective: To evaluate the dose of enoxaparin needed to achieve therapeutic anti-Xa levels in a prospective, masked observational cohort of heterogeneous inpatients with morbid obesity and to determine whether patients with morbid obesity treated with 1 mg/kg of enoxaparin are at increased risk of supratherapeutic levels and bleeding events compared to patients receiving lower doses.

Methods: Hospitalized patients with a body mass index ≥40 kg/m(2) or actual body weight ≥140 kg and prescribed treatment doses of enoxaparin >60 mg per day were enrolled and consented to phlebotomy for determination of anti-Xa levels.

Case report: Severe hypercalcemia mimicking ST-segment elevation myocardial infarction.

The identification of ST-segment elevation on the electrocardiogram is an integral part of decision making in patients who present with suspected ischemia. Unfortunately, ST-segment elevation is nonspecific and may be caused by noncardiac causes such as electrolyte abnormalities. We present a case of ST-segment elevation secondary to hypercalcemia in a patient with metastatic cancer.

Comparison of anti-Xa and activated partial thromboplastin time monitoring for heparin dosing in patients with cirrhosis.

Background: Cirrhosis of the liver results in complex hemostatic changes that place patients at risk for both bleeding and thrombotic events. This study evaluates the adverse effects of anticoagulation with unfractionated heparin among patients with cirrhosis and analyzes the discrepancy between anti-Xa and activated partial thromboplastin time (aPTT) values for heparin monitoring among cirrhotics.

Methods: Patients with cirrhosis receiving unfractionated heparin were matched 2:1 to patients without evidence of cirrhosis anticoagulated with unfractioned heparin.

Assessment of drug-induced torsade de pointes risk for hospitalized high-risk patients receiving QT-prolonging agents.

Background: Although risk factors for torsade de pointes (TdP) are known, identifying hospitalized patients at greatest risk for QTcP who should receive cardiac monitoring is poorly defined.

Objectives: Describe the prevalence of risk for TdP in patients and associations between risk factors and QTc prolongation (QTcP) at a tertiary teaching hospital.

Methods: This retrospective analysis assessed physiological and pharmacological risk factors for TdP of adult patients receiving ≥1 QTc-prolonging medications (QTcMed) during hospitalization.

Low molecular weight heparin dosing and monitoring in solid organ transplant recipients.

Anti-Xa monitoring for low molecular weight heparin (LMWH) is currently recommended in obese, renally impaired, and pregnant patients. Substantial evidence indicates that solid organ transplant (SOT) patients are at an increased risk of renal impairment, thus representing a population at risk of LMWH accumulation. The purpose of this study was to review our experience with LMWH dosing and monitoring in a cohort of transplant recipients.

Alternative monitoring of argatroban using plasma-diluted thrombin time.

Objective: To report a case of heparin-induced thrombocytopenia (HIT) in a patient with concurrent liver dysfunction and a prolonged baseline activated partial thromboplastin time (aPTT) in whom argatroban therapy was monitored with aPTT and a novel plasma-diluted thrombin assay.

Case Summary: An 80-year-old man with HIT and liver dysfunction was treated with argatroban, which was initiated at a dose of 0.5 μg/kg/min and gradually decreased to 0.

New agents to prevent strokes in nonvalvular atrial fibrillation.

Anticoagulation for atrial fibrillation has been dependant on warfarin for the past 30 years. However, the recent FDA approvals of dabigatran and rivaroxaban and the expected approval for apixaban have provided several new alternatives for our patients. Many factors must be considered when selecting the most appropriate agent for preventing stroke in nonvalvular atrial fibrillation.

Cardioprotective medication use after renal transplantation.

Cardiovascular disease is the leading cause of death in renal transplant patients. This study compares the use of cardioprotective medications in adult kidney transplant recipients at a single center with recommendations, which have been validated in the general population. Cardioprotective medication use was retrospectively collected post-renal transplant.

Impact of computerized dosing on eptifibatide-associated bleeding and mortality.

Objective: The study aimed to determine the impact on eptifibatide-associated bleeding by implementing a computerized dosing algorithm in the cardiac catheterization suite.

Background: Excessive dosing of eptifibatide is associated with increased bleeding rates and hospital mortality. Although dosing adjustments based on renal function has been recommended, its implementation and clinical impact have not been assessed in daily practice.

The Methodist Hospital CCU: a Beacon unit of excellence.

This article features the Coronary Care Unit of The Methodist Hospital of Houston, Texas. This unit was one of the first Beacon Critical Care Units recognized by the American Association of Critical Care Nurses. This article focuses on how to achieve this award.

Post-surgical recovery and time-of-day mask potentiated responses of ACTH to repeated moderate hemorrhage in conscious rats.

We determined how changes in the responsiveness of the hypothalamo-pituitary-adrenal (HPA) system that accompany experimentation affect facilitation of HPA responses to hemorrhage. Hemorrhage (10 ml/kg over 3 min) was performed in conscious, chronically prepared rats. Blood was sampled over 1 h followed by reinfusion of shed blood.