In a retrospective study involving 449 patients with severe COVID-19 requiring intensive care unit admission, those patients with a positive sepsis coagulation score or D-dimer greater than 3.0 mcg/mL who received prophylactic doses of low molecular weight heparin exhibited lower 28-day mortality.
In a randomized trial of patients already on anticoagulation undergoing transcatheter aortic valve replacement, adding clopidogrel to oral anticoagulation increased the incidence of serious bleeding vs. oral anticoagulation alone, but did not improve cardiovascular outcomes.
A large outpatient observational study of patients with atrial fibrillation and chronic kidney disease who were anticoagulated revealed that, compared to warfarin, direct oral anticoagulants exhibited less all-cause mortality and major bleeding with at least equivalent efficacy at preventing stroke.
Low-risk pulmonary embolus patients discharged in < 48 hours on rivaroxaban recorded a nominal three-month rate of recurrent emboli or major bleeding, suggesting such patients do not need to be hospitalized for treatment of pulmonary emboli.
A simple protocol for managing atrial fibrillation patients on direct oral anticoagulants perioperatively was shown to produce low levels of major bleeding and thromboembolism for 30 days postoperatively.
Using the Delphi method of arriving at a consensus among clinicians concerning to whom with atrial fibrillation to recommend oral anticoagulants, the risk of stroke, the risk of hemorrhage, and patient-specific factors emerged. Many of these factors are not included in the guidelines and should be studied further.
Penetrating extremity trauma is a potentially devastating injury that must be identified and managed expeditiously. Early hemorrhage control may be life-saving. This two-part article comprehensively addresses the approach and management of penetrating extremity trauma, highlighting controversies and advances.