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When can we stop anticoagulation in patients with cancer-associated thrombosis?
Authors: Lee AYY Abstract The optimal duration of anticoagulant therapy in patients with cancer-associated venous thromboembolism (VTE) is unknown. Without well-designed studies evaluating the efficacy, safety, and cost-effectiveness of continuing anticoagulant therapy beyond the acute treatment period of 3 to 6 months, evidence-based recommendations are lacking. Consensus guidelines generally suggest continuing anticoagulation treatment in patients with active cancer or receiving cancer treatment, with periodic reassessment of the risks and benefits. Unfortunately, with very little published data on the epidemiolo...
Source: Hematology ASH Education Program - December 10, 2017 Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research

Medical and surgical abortion for women living with HIV.
CONCLUSIONS: Due to the paucity of studies, we were unable to determine if outcome differences exist between women living with HIV and women without HIV who undergo medical or surgical abortion. We found no evidence suggesting that medical or surgical abortions are unsafe for women living with HIV. While additional research would strengthen the evidence base, healthcare providers should not be deterred from providing access to safe abortion to their patients living with HIV. PMID: 30566226 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 19, 2018 Category: General Medicine Authors: Saleem HT, Narasimhan M, Ganatra B, Kennedy CE Tags: Cochrane Database Syst Rev Source Type: research

Aspirin Therapy for Primary Prevention: The Case for Continuing Prescribing to Patients at High Cardiovascular Risk-A Review.
Abstract Current evidence supports the use of low-dose aspirin for secondary cardiovascular prevention. By contrast, the benefit-to-risk ratio of aspirin use in primary prevention is debated: three contemporary randomized control trials have been conflicting, and meta-analyses have concluded for an unclear clinical benefit, based on the consideration that the reduction in thromboembolic events is counterbalanced by increased bleeding. The primary prevention setting is, however, a heterogeneous mix of subjects at highly variable cardiovascular risk. One possible explanation for the uncertainty of data interpretatio...
Source: Thrombosis and Haemostasis - December 29, 2019 Category: Hematology Authors: De Caterina R, Aimo A, Ridker PM Tags: Thromb Haemost Source Type: research

FAST Program Implementation Guide Success
Jefferson Antithrombotic Therapy Team. Front row L to R: Photi Galanis, MD, Julia Westfield, Heather Yenser, CRNP. Back row L to R: Lynda Thomson, PharmD, Dina Orapallo, CRNP, Geno Merli, MD, Tony Macchiavelli, MD, Walter Kraft, MD, Luis Eraso, MD Hospital clinicians know well that managing anticoagulation therapy for their patients with venous thromboembolism (VTE) and other thrombotic conditions can be a balancing act between preventing further life-threatening blood clots and avoiding dangerous bleeds—both high-risk adverse events leading to diminished quality of life and worse, for patients. These challenges are int...
Source: The Hospitalist - February 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Education Patient Safety Practice Management Quality Improvement Transitions of Care Venous Thromboembolism Source Type: research

Doctors should 'wait longer' before diagnosing miscarriage
ConclusionThis observational study reviewed the reliability of different measurements taken at a transvaginal ultrasound scan to diagnose miscarriage during early pregnancy. The recommended cut-off values for gestational sac diameter and embryo crown-to-rump length were changed in 2011 based on a number of reports, with mixed findings suggesting previous ones may have been unreliable. This study looked at the performance of currently used cut-off values, and found that the current cut-offs used to diagnose miscarriage are reliable. No healthy, continuing pregnancies would be wrongly diagnosed as miscarriage using these va...
Source: NHS News Feed - September 25, 2015 Category: Consumer Health News Tags: Medical practice Pregnancy/child Source Type: news

Long-term prognosis in patients continuing taking antithrombotics after peptic ulcer bleeding.
CONCLUSION: After the occurrence of peptic ulcer bleeding, continuing antithrombotics increases the risk of recurrent bleeding events, while discontinuing antithrombotics would increase the risk of death and developing cardiovascular disease. This suggests that clinicians should comprehensively consider the use of antithrombotics after peptic ulcer bleeding. PMID: 28216980 [PubMed - in process]
Source: World Journal of Gastroenterology : WJG - January 27, 2017 Category: Gastroenterology Authors: Wang XX, Dong B, Hong B, Gong YQ, Wang W, Wang J, Zhou ZY, Jiang WJ Tags: World J Gastroenterol Source Type: research

63: evidence based practical guideline for the management of major hemorrhage in children and teenagers
Conclusion: Medical, nursing and midwifery staff involved in frontline care must be trained to recognize major blood loss early, know when to activate the local major hemorrhage protocol and take prompt and appropriate action (1D). Annual workshops for continuous medical education are highly suggested.
Source: BMJ Open - February 7, 2017 Category: Journals (General) Authors: Shahriari, M. Tags: Open access Poster Source Type: research

Gastroduodenal Surgery: A Persistent and Continuing Challenge.
Abstract The number of patients being treated surgically for gastroduodenal disease has decreased over the past five decades as a result of focus on medical treatment. However, perforated and bleeding peptic ulcer disease (PUD) continues to represent a significant percentage of patients who require emergency surgery. The aim of this study was to characterize these critically ill surgical patients treated for gastroduodenal disease in our hospital. A retrospective, single-center, consecutive cohort study of all patients identified from the hospital National Surgical Quality Improvement Program database who were adm...
Source: The American Surgeon - July 1, 2018 Category: Surgery Authors: Melmer PD, Banks T, Holmes S, Sciarretta JD, Davis JM Tags: Am Surg Source Type: research

Medical versus surgical treatment for refractory or recurrent peptic ulcer.
CONCLUSIONS: We found no studies that provide the relative benefits and harms of medical versus surgical treatment for recurrent or refractory peptic ulcers. Studies that evaluate the natural history of recurrent and refractory peptic ulcers are urgently required to determine whether randomised controlled trials comparing medical versus surgical management in patients with recurrent or refractory peptic ulcers or both are necessary. Such studies will also provide information for the design of such randomised controlled trials. A minimum follow-up of two to three years will allow the calculation of the incidence of complica...
Source: Cochrane Database of Systematic Reviews - March 28, 2016 Category: Journals (General) Authors: Gurusamy KS, Pallari E Tags: Cochrane Database Syst Rev Source Type: research

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities
Conclusion. Levels of acceptability among continuing users were high, mainly linked to the method’s convenience. While early favourable views drove uptake, negative perceptions, if unaddressed, may now undermine services. Deficiencies in counselling around effectiveness and side-effects may extend to contraceptive services more generally. Women require more intensive support when experiencing sideeffects, including effective systematic approaches to ameliorating bleeding and headaches. Implant services could specifically target young women and first-time contraceptive users. These actions together could reverse the persi...
Source: South African Medical Journal - February 7, 2018 Category: African Health Tags: S Afr Med J Source Type: research

Limited Impact of Clinician Education on Reducing Inappropriate PF4 Testing for Heparin-Induced Thrombocytopenia
ConclusionOur study revealed that calculation of 4T scores remains poor and is not universally applied, suggesting that clinician education alone is insufficient. We also observed divergent 4T scores with the ordering clinician calculating a higher 4T score compared to the Hematology QI team. As such, introducing mandatory 4T score calculation prior to PF4-ELISA testing may not be helpful as ordering clinicians can bypass the restriction through inaccurate 4T score calculation.The majority of PF4-ELISA testing was performed in the ICU setting. This is concerning as studies have shown that thrombocytopenia is a common labor...
Source: Blood - November 21, 2018 Category: Hematology Authors: Malalur, P., Greenberg, C., Lim, M. Y. Tags: 901. Health Services Research-Non-Malignant Conditions: Bone Marrow Transplantation and Benign Hematology Source Type: research

These 2 medical devices have sparked controversy
Sandra Maddock, president, IMARC Research The history of clinical research is filled with unfortunate examples of drug and device trials that involved serious ethical violations, injured patients or even resulted in death. It’s a sobering reminder of the many risks medical devices can pose to patients and the importance of compliance in clinical trials. Although many of these events occurred decades ago, medical devices still have the potential to cause harm. These issues are documented in the FDA’s annual list of medical device recalls and (in some rare cases) even make headlines. Here are two examples of more recen...
Source: Mass Device - March 5, 2019 Category: Medical Devices Authors: Danielle Kirsh Tags: Blog IMARC Source Type: news

Who benefits from percutaneous closure of patent foramen ovale vs medical therapy for stroke prevention? In-depth and updated meta-analysis of randomized trials.
CONCLUSION: In certain groups of patients presenting with stroke, PFOC is beneficial in preventing future stroke compared to medical therapy. PMID: 31110604 [PubMed]
Source: World Journal of Cardiology - April 25, 2019 Category: Cardiology Authors: Dahal K, Yousuf A, Watti H, Liang B, Sharma S, Rijal J, Katikaneni P, Modi K, Tandon N, Azrin M, Lee J Tags: World J Cardiol Source Type: research

Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?
CONCLUSIONS Continuing anticoagulation or antiplatelet was safe in not increasing bleeding complications or perioperative transfusion requirements. Outcomes were similar at 3 and 6 months among groups. This strategy avoids exposing patients to risk of thrombosis if treatment is held and simplifies proceeding to transplantation.PMID:34580271 | DOI:10.12659/AOT.931648
Source: Annals of Transplantation - September 28, 2021 Category: Transplant Surgery Authors: Jose C Alonso-Escalante Lorenzo Machado Kiumars R Tabar Rachell Tindall Ngoc Thai Tadahiro Uemura Source Type: research