Evaluation of prophylactic heparin dosage strategies and risk factors for venous thromboembolism in the critically ill patient

AbstractBackgroundVenous thromboembolism (VTE) occurs frequently in critically ill patients without heparin prophylaxis. Although heparin prevents VTE, VTEs occur frequently despite prophylaxis. Higher heparin dosage may be more effective for preventing VTE.MethodsA retrospective study was conducted utilizing the Premier Incorporated Perspective Database to comparatively evaluate the effects of different heparin prophylaxis dosing strategies in the critically ill patient. Critically ill adult patients who were mechanically ventilated for at least 1 day and had an Intensive Care Unit (ICU) length of stay of at least 2 days were included. Patients received 5000 units of heparin either twice (BID) or three times daily (TID). The primary outcome was development of a new VTE. Key secondary outcomes included clinically important bleeding, thrombocytopenia, and mortality. Patients were propensity matched to control for confounding. Multivariable analysis was conducted for VTE risk factors.ResultsThe study included 30,800 patients from 374 hospitals that were propensity matched by heparin dosage. New VTE occurred in 6.2% of patients treated with TID heparin versus 6.2% with BID heparin (P=0.8). No significant differences in the incidence of pulmonary embolism (0.91% vs 0.8%, P=0.29) or deep venous thrombosis (5.56% vs 5.70% P=0.59) were observed between BID and TID heparin dosing. There were no differences between TID heparin and BID heparin in hospital mortality (15.8% vs 15.15%), b...
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - Category: Drugs & Pharmacology Authors: Tags: SI on Prevention Strategies in the Critically Ill Source Type: research

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Publication date: Available online 22 February 2020Source: Journal of Pharmaceutical AnalysisAuthor(s): Max Sauter, Philipp Uhl, Jürgen Burhenne, Walter E. HaefeliAbstractExenatide is the first approved glucagon-like peptide 1 receptor agonist subcutaneously or intramuscularly injected for the treatment of type 2 diabetes mellitus. Typical therapeutic plasma concentrations are in the low pg/mL range therefore requiring ultra-sensitive quantification. To enable the accurate evaluation of pharmacokinetic studies, we established a UPLC-MS/MS assay with a lower limit of quantification (LLOQ) of 5 pg/mL (1.2 pM) using 20...
Source: Journal of Pharmaceutical Analysis - Category: Drugs & Pharmacology Source Type: research
Conclusion: Taken together, these results suggest that SXD maybe alleviate EMT in DN via the inhibition of the TGF-β1/Smad/RUNX3 signaling pathway under hyperglycemic conditions.Graphical abstract
Source: Phytomedicine - Category: Drugs & Pharmacology Source Type: research
We report a case of migration of arterial stent, placed in the right iliac vein into the right pulmonary artery which was diagnosed there and subsequently not removed for at least 3 years. Despite reports in the literature for the removal of migrated stents by mini-invasive interventional methods, in our case, this was not possible, because of the long period for which the foreign body was in the right pulmonary artery and the proximal partial occlusion of organized mural thrombus.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Authors: Di Lullo L, Bellasi A, Guastamacchia E, Triggiani V, Ronco C, Lavalle C, Di Iorio BR, Russo D, Cianciolo G, La Manna G, Settembrini S Abstract Diabetes mellitus, with its complications, is one of the major health problems in economically developed countries and its prevalence is constantly increasing. Kidneys and heart involvement represent main comorbidities in diabetic patients often leading to organ's failure. The treatments available until a few years ago are often associated with hypoglycemia, weight gain, gastro-intestinal disorders and other side effects together with serious averse effects on renal...
Source: Minerva Cardioangiologica - Category: Cardiology Tags: Minerva Cardioangiol Source Type: research
Authors: De Vecchis R, Paccone A, Di Maio M Abstract BACKGROUND: The MacNew questionnaire in its original version is a diagnostic tool which consists of a number of questions answered on a seven-point scale. Among the multiple possible choices, each marked by a box, the examined patient will have to tick only one. In fact, more than one answer for each proposed question is not allowed, for the formulation of the final score. Global and subscale( physical, social and emotional subscales) scores are computed by dividing the sum of the scores achieved for each individual item by the number of items listed in the quest...
Source: Minerva Cardioangiologica - Category: Cardiology Tags: Minerva Cardioangiol Source Type: research
Authors: De Vecchis R, Paccone A, Di Maio M Abstract INTRODUCTION: The guidelines of the Scientific Societies of Cardiology suggest limiting water intake in the diet as one of the non-pharmacological measures for the management of chronic heart failure. However, many patients with heart failure may suffer from severe thirst, even irrespective of a possible restricted fluid intake, and this has received relatively little attention in clinical studies. Moreover, definitive and irrefutable evidence that documents the efficacy of the limitation in water consumption on major cardiovascular outcomes is lacking. Therefore...
Source: Minerva Cardioangiologica - Category: Cardiology Tags: Minerva Cardioangiol Source Type: research
CONCLUSIONS: Not all interventional procedures result in a mortality benefit. Medical therapy alone increases survival in many cardiac diseases. PMID: 32083425 [PubMed - as supplied by publisher]
Source: Minerva Cardioangiologica - Category: Cardiology Tags: Minerva Cardioangiol Source Type: research
Authors: Caixàs A, Villaró M, Arraiza C, Montalvá JC, Lecube A, Fernández-García JM, Corio R, Bellido D, Llisterri JL, Tinahones FJ Abstract The high prevalence of obesity in our environment, a chronic disease of complex management and responsible for multiple comorbidities, requires the implementation of coordination strategies in clinical care between primary care and specialist hospital units. In a cross-sectional care model, primary care physicians guide all therapeutic management related to obesity. Together with them, specialists in endocrinology and nutrition and other heal...
Source: Medicina Clinica - Category: General Medicine Tags: Med Clin (Barc) Source Type: research
Publication date: Available online 22 February 2020Source: Computational and Structural Biotechnology JournalAuthor(s): Abhijit Dasgupta, Gautam K. Bandyopadhyay, Indrani Ray, Keya Bandyopadhyay, Nirmalya Chowdhury, Rajat K. De, Sushil K. MahataAbstractObesity is characterized by a state of chronic, unresolved inflammation in insulin-targeted tissues. Obesity-induced inflammation causes accumulation of proinflammatory macrophages in adipose tissue and liver. Proinflammatory cytokines released from tissue macrophages inhibits insulin sensitivity. Obesity also leads to inflammation-induced endoplasmic reticulum (ER) stress a...
Source: Computational and Structural Biotechnology Journal - Category: Biotechnology Source Type: research
This article summarizes research of our laboratory aimed at identifying neuroadaptations induced by chronic food restriction (FR) that increase the reward magnitude of drugs and associated cues. The main findings are that FR decreases basal dopamine (DA) transmission, upregulates signaling downstream of the D1 DA receptor (D1R), and triggers synaptic incorporation of calcium-permeable AMPA receptors (CP-AMPARs) in the nucleus accumbens (NAc). Selective antagonism of CP-AMPARs decreases excitatory postsynaptic currents in NAc medium spiny neurons of FR rats and blocks the enhanced rewarding effects of d-amphetamine and a D1...
Source: Physiology and Behavior - Category: Physiology Source Type: research
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