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Clinical Outcome Following Reinstitution of Anticoagulation after Major Gastrointestinal Bleed: A Single Institutional Analysis
Conclusion: Given the rising national trend on the use of anticoagulants for various medical necessities, it is imperative that a safe and efficient process be devised on reinstitution of anticoagulation post MGIB to guide Clinicians. Although our study represents a single institutional analysis, it concurs with recent studies that early resumption of anticoagulant following stabilization of MGIB is associated with lower thromboembolic events. Timing for resumption depends largely on the medical reason for anticoagulation; reinstitution by day 7 appear safe for patients on mechanical valve whereas after day 12 maybe approp...
Source: Blood - November 21, 2018 Category: Hematology Authors: Ezekwudo, D. E., Gaikazian, S., Anusim, N., Konde, A. S., Zakalik, D., Huben, M. T., Stender, M., Anderson, J., Jaiyesimi, I. Tags: 332. Antithrombotic Therapy: Poster I Source Type: research

Fool Me Once: An Uncommon Presentation of PE
​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; & AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and i...
Source: The Case Files - November 27, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Firefighting and On-Duty Cardiac Deaths
Conclusion Using autopsy data from on-duty fatalities that occurred over a 15-year period, the underlying cardiac pathological conditions associated with sudden cardiac death were investigated among firefighters. Our data suggest a need for updated and improved medical screening for firefighters. Particularly, screening for CHD and cardiac enlargement should be incorporated into a firefighter’s routine screening. Given the important role of EMS in ensuring both civilian and firefighter safety, EMS personnel should be alert to the potential to encounter either sudden cardiac arrest or a myocardial infarction in firefighte...
Source: JEMS Special Topics - November 12, 2018 Category: Emergency Medicine Authors: Denise L. Smith, PhD, FACSM Tags: Training Exclusive Articles Source Type: news

Endovascular Thrombolysis or Thrombectomy for Cerebral Venous Thrombosis: Study of Nationwide Inpatient Sample 2004-2014
In this study, we analyze Nationwide Inpatient Sample (NIS) data to evaluate the safety and efficacy of endovascular therapy (ET) versus medical management in CVT. We also examined the yearly trends of ET utilization in the United States. Methods: International Classification of Diseases, Ninth Revision, Clinical Modification codes were utilized to identify CVT patients who received ET.
Source: Journal of Stroke and Cerebrovascular Diseases - April 1, 2019 Category: Neurology Authors: Fazeel M. Siddiqui, Matthew W. Weber, Sudeepta Dandapat, Steve Scaife, Michael Buhnerkempe, Santiago Ortega-Gutierrez, Nazan Aksan, Augusto Elias, Jonathan M. Coutinho Source Type: research

A Novel Homozygous Non-sense Mutation in the Catalytic Domain of MTHFR Causes Severe 5,10-Methylenetetrahydrofolate Reductase Deficiency
Conclusion: We identified a novel non-sense mutation in MTHFR gene in a single Egyptian family with severe MTHFR deficiency. The present investigation is clinically important, as it adds to the growing list of MTHFR mutations, which might help in genetic counseling of families of affected children and proper genotype-phenotype correlation. Background Severe 5,10-Methylenetetrahydrofolate reductase (MTHFR; OMIM 236250) deficiency is a rare inborn error of metabolism and inherited in an autosomal recessive fashion. It is a very common disorder of folate metabolism and is clinically characterized with low plasma methion...
Source: Frontiers in Neurology - April 23, 2019 Category: Neurology Source Type: research

Associations between use of prasugrel vs clopidogrel and outcomes by type of acute coronary syndrome: an analysis from the PROMETHEUS registry
AbstractWe sought to investigate the utilization of prasugrel and its association with outcomes relative to clopidogrel in three typical subgroups of ACS in a real-world setting. Prasugrel is superior to clopidogrel for reducing risk of ischemic events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), but is associated with an increased risk of bleeding complications. PROMETHEUS was a retrospective multicenter observational study of 19,913 ACS patients undergoing PCI from 8 centers in the United States between 2010 and 2013. Major adverse cardiovascular events (MACE) were define...
Source: Journal of Thrombosis and Thrombolysis - June 8, 2019 Category: Hematology Source Type: research

Asian Study of Cerebral Venous Thrombosis
The objective of the present study is to identify risk factors, presentation, and outcome of CVT in Asian patients. Methods: Asian CVT registry is a prospective multinational observational study that included patients (aged> 16 years) with symptomatic CVT. Results: Eight hundred and twelve patients (59% women) from 20 centers in 9 Asian countries were included.
Source: Journal of Stroke and Cerebrovascular Diseases - July 23, 2019 Category: Neurology Authors: Mohammad Wasay, Subash Kaul, Bindu Menon, Alper I. Dai, Mohammad Saadatnia, Abdul Malik, Ahmed Khalifa, Afshin Borhani-Haghigi, Manmohan Mehndiratta, Maria Khan, Nimalendu Bikash Bhowmik, Safia Awan Source Type: research

Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association.
ular Biology; Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology Abstract Hypertriglyceridemia (triglycerides 200-499 mg/dL) is relatively common in the United States, whereas more severe triglyceride elevations (very high triglycerides, ≥500 mg/dL) are far less frequently observed. Both are becoming increasingly prevalent in the United States and elsewhere, likely driven in large part by growing rates of obesity and diabetes mellitus. In a 2002 American Heart Association scientific stat...
Source: Circulation - August 18, 2019 Category: Cardiology Authors: Skulas-Ray AC, Wilson PWF, Harris WS, Brinton EA, Kris-Etherton PM, Richter CK, Jacobson TA, Engler MB, Miller M, Robinson JG, Blum CB, Rodriguez-Leyva D, de Ferranti SD, Welty FK, American Heart Association Council on Arteriosclerosis, Thrombosis and Vas Tags: Circulation Source Type: research

Assessing patient preferences for switching from warfarin to direct oral anticoagulants
This study assessed patient preference for warfarin or DOAC based on a willingness to pay more for potential DOAC benefits. Current warfarin patients with atrial fibrillation or venous thromboembolism enrolled in the University of Utah Health Thrombosis Service were given a one-time electronic survey that assessed preferences between warfarin and DOACs using scenarios comparing effectiveness, safety, and convenience. When DOACs were preferred, patients were asked how much more they would be willing to pay monthly for the perceived advantages associated with DOACs. With 123 completed surveys, 68% of patients preferred to st...
Source: Journal of Thrombosis and Thrombolysis - October 19, 2019 Category: Hematology Source Type: research

Surgical Techniques for Implanting the EVAHEART 2 Double Cuff Tipless Inflow Cannula
The EVAHEART 2 (Sun Medical Technology Research Corporation, Nagano, Japan) is an investigational centrifugal ventricular assist device in the United States, introduced a new type inflow, named “double cuff tipless” inflow cannula intended to mitigate the risks of cannula malposition and subsequent ischemic stroke events associated with thrombi around the inflow cannula. To achieve these performance benefits of the “tipless” design, however, it is crucial to adhere to the recommended surgical procedure. We introduced a polymer-based patient model that mimics a dilated cardiomyopathy apex for inflow cannula implanta...
Source: ASAIO Journal - November 1, 2019 Category: Medical Devices Tags: How to do it Article Source Type: research

Algorithmic anticoagulation: streamlining the decision to hold and restart blood thinners in the periendoscopy period
The number and complexity of procedures performed by gastroenterologists are increasing in the United States.1,2 In addition, the number and complexity of antithrombotic agents are growing.3 These concurrent trends may lead to confusion among providers on the  appropriate management of these drugs during endoscopy. The skilled clinician must balance the risks of thrombosis, including myocardial infarction and stroke, against the risks of procedure-related hemorrhage, which can be potentially fatal.
Source: Gastrointestinal Endoscopy - November 20, 2019 Category: Gastroenterology Authors: Theodore W. James, Todd H. Baron Tags: Original article Source Type: research

Contemporary Meta-Analysis of Extended Direct Acting Oral Anticoagulant Thromboprophylaxis to Prevent Venous Thromboembolism Among Hospitalized Patients
There are over 36 million medical hospitalizations each year in the United States, with the majority being for acute medical illness.1 Cancer, chronic obstructive pulmonary disease, congestive heart failure, stroke and myocardial infarction are some of the most common indications for hospitalization and are additionally risk factors for venous thromboembolism.2 With over 900,000 patients suffering from venous thromboembolism each year, excess thrombosis causes a large medical and financial burden to patients and the health care system.
Source: The American Journal of Medicine - March 5, 2020 Category: General Medicine Authors: Vikas Bhalla, Olivia F Lamping, Ahmed Abdel-Latif, Meenakshi Bhalla, Khaled Ziada, Susan S. Smyth Tags: Clinical Research Study Source Type: research

Cannabis Use Disorder and Perioperative Outcomes in Major Elective Surgeries A Retrospective Cohort Analysis
Conclusions An active cannabis use disorder is associated with an increased perioperative risk of myocardial infarction.Editor ’s PerspectiveWhat We Already Know about This TopicCannabis is known to have cardiovascular and psychoactive effectsThe association between active cannabis use disorder and postoperative outcomes remains unclearWhat This Article Tells Us That Is NewIn the United States, administrative data demonstrate that cannabis use disorder has increased in prevalence from 2010 to 2015Active cannabis use disorder is not associated with a change in overall perioperative morbidity, mortality, length of stay, or...
Source: Anesthesiology - March 10, 2020 Category: Anesthesiology Source Type: research

Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1713128Given a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of “tobacco use disorder.” Patient characteristics as well as prevalence, costs, and incidence of complications were compared. ...
Source: Journal of Knee Surgery - June 23, 2020 Category: Orthopaedics Authors: Rajaee, Sean S. Debbi, Eytan M. Paiement, Guy D. Spitzer, Andrew I. Tags: Original Article Source Type: research

Scientific Approach to Assess if Change Led to Improvement —Methods for Statistical Process Control Analysis in Quality Improvement
Quality improvement is an expectation in most hospitals and emergency departments throughout the United States. With hospitals requiring reporting on key metrics such as readmission rates, time to thrombolytic administration in stroke, or time to cardiac catheterization laboratory activation for ST-elevation myocardial infarctions, many emergency departments deploy quality improvement teams to monitor and improve these metrics and others to promote quality and safety. Emergency nurses and managers are key members and leaders of these quality improvement teams.
Source: Journal of Emergency Nursing: JEN - October 23, 2020 Category: Nursing Authors: Maegan S. Reynolds, Sandra P. Spencer, Ashley Dunaway, Don Buckingham, Thomas Bartman Tags: Understanding Research Source Type: research

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