Hospital Medicine Alert – November 1, 2009
November 1, 2009
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Alternative Dosing of Oseltamivir for Specific Patient Populations: Critically Ill and Renally Impaired
Oseltamivir (Tamiflu®) is an FDA-approved drug for the treatment and prevention of influenza. With the anticipated emergence of seasonal influenza virus cases in October, and the recent discoveries of novel H5N1 (avian) and 2009 H1N1 (swine) influenza viruses, it is imperative to understand how to appropriately dose oseltamivir. -
Are We Causing PTSD with Our Current Sedation Practices?
This randomized, single-center study demonstrated that light-sedation strategies in a mixed surgical and medical ICU population are associated with decreased ICU length-of-stay and duration of mechanical ventilation without adverse effects on patient safety or mental well-being. -
New Data on Warfarin Therapy for Atrial Fibrillation
Current recommendations for stroke prophylaxis with warfarin for patients with atrial fibrillation do not take into account the risks of hemorrhage. Thus, Singer et al from Kaiser Permanente studied more than 13,000 patients with non-valvular atrial fibrillation to estimate the net clinical benefit of warfarin therapy for atrial fibrillation (reduction in thromboembolism minus the increase in intracranial hemorrhage). -
A New Antiplatelet Agent for Patients with ACS
Dual antiplatelet therapy with aspirin and clopidogrel has become the standard of care for patients suffering an acute coronary syndrome (ACS). However, there remains a significant incidence of recurrent ACS and mortality even in patients treated with dual antiplatelet therapy. Furthermore, clopidogrel is an irreversible platelet inhibitor, and patients requiring urgent surgery are at higher risk of bleeding if operated on within 5-7 days of clopidogrel use.