Hospital Medicine Alert – October 1, 2008
October 1, 2008
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Should We Transfuse Patients with Subarachnoid Hemorrhage?
Although anemia was predictive of adverse outcomes in patients with aneurysmal subarachnoid hemorrhage, red blood cell transfusion was also associated with an increased risk of death, severe disability or delayed infarction. These results call into question the practice of liberal transfusion thresholds in patients with spontaneous subarachnoid hemorrhage. -
Imatinib for Acute Ischemic Stroke
Blockage of the harmful effects of tissue plasminogen activator by imatinib (Gleevec) might improve ischemic stroke outcomes. -
Improving Appropriate Use of Prophylactic Antibiotics
In spite of institutional education regarding appropriate use of prophylactic antibiotics, compliance was achieved only when hospital protocols that mandated specific antibiotic use were implemented. -
Accuracy of the ECG for STEMI
Although the ECG is key in the triage of suspected ST wave elevation myocardial infarction (STEMI), it is imperfect. -
Lack of Residual Vein Thrombosis Predicts for Low Risk of Recurrent DVT
The optimal duration of oral anticoagulation therapy after an initial symptomatic deep venous thrombosis remains unknown. Siragusa et al assessed patients by ultrasonography for the presence of residual vein thrombosis (RVT) after three months of anticoagulation for a DVT. Those with RVT were randomized to 9 additional months of anticoagulation versus discontinuation. Among the 70% with RVT, prolonged anticoagulation showed only a non-significant trend for reducing recurrent DVT. For the 30% without RVT, all of whom stopped anticoagulation after three months, only one of 78 patients (1.3%) developed a recurrent DVT. For select patients, the lack of RVT after initial anticoagulation identifies patients in whom anticoagulation may be safely discontinued. The optimal duration of anticoagulation for higher risk patients, including those with RVT, remains undefined.