Emergency Medicine Literature of Note
Musings on Emergency Medicine, Clinical Informatics, & High-Value Care.
This is rivaroxaban, an oral Factor Xa inhibitor, part of the wave of potential warfarin replacements. This is their phase III EINSTEIN-PE trial, which is a non-inferiority comparison against warfarin for the long-term outpatient management of pulmonary embolism. Overall, it was slightly less effective at prevention of recurrent venous thromboembolism (2.1% vs 1.8%), but slightly … Continue reading “Rivaroxaban and Pulmonary Embolism”
Imagine my surprise to be paging through Emergency Medicine News this month and stumble upon an article about TPA in stroke – and find that it’s a review of my Western Journal of Emergency Medicine article from last summer. The EM News article is here:http://journals.lww.com/em-news/Fulltext/2012/03000/Journal_Scan__Pharma_Bias_Detected_in_Thrombolytic.6.aspx And my West JEM article is open access, available here:http://escholarship.org/uc/item/9504g8md
Yet again, another article that saturated the lay press due to its publication in JAMA – this time regarding amoxicillin for acute sinusitis. The problem is, I agree with the fundamental point the authors are making – according to the introduction, antibiotics for sinusitis account for 1 in 5 antibiotic prescriptions in the United States … Continue reading “The Tiniest Three Year Sinusitis Trial”
After publishing an article that alluded to the “antipathy” of emergency physicians towards TPA in acute ischemic stroke, the editors were nice enough to publish my correspondence defending the reasonableness of a cautious attitude.“Skepticism about thrombolytics in stroke is not unreasonable.”http://www.ncbi.nlm.nih.gov/pubmed/22249840
Or, if it does, this is not the article that shows it. It tries to show it – and Rick Bukata, who I love, includes it as part of his PE review in this month’s Emergency Physician’s Monthly. It’s a year and a half old, but I had to pull it because I’ve presented other … Continue reading “Early Heparin Does Not Save Lives in Pulmonary Embolism”
Mentioned in Journal Watch: Stroke – http://emergency-medicine.jwatch.org/cgi/content/full/2011/1118/5 …regarding my recently published article regarding pharmaceutical ties to thrombolysis literature. No idea what the review says – since I don’t subscribe to the service!
This is a non-TPA article regarding the medical management of hypertension in acute ischemic stroke in the Emergency Department. The authors remind us that for every 10 mmHg drop in SBP <150 mmHg, there is a 17.9% increase in risk for death at 14 days. They additionally remind us that antihypertensive therapy is only recommended … Continue reading “ED Blood Pressure Management In Acute Stroke Is Terrible”
Yet again, in the “little things matter more” series of dull, but important, Emergency Department literature. TPA or no, what matters more in terms of their ultimate outcome is everything that happens down the line. This is a retrospective review of consecutively-collected prospective registry data for acute ischemic stroke patients in Louisiana, looking at patients … Continue reading “ED Nursing Hand-Offs & Stroke Outcomes”
Intraventricular TPA for intraventricular hemorrhage – I wouldn’t call it counter-intuitive, but I would certainly call it unusual. This is a small placebo-controlled, randomized, blinded, prospective trial enrolling 48 patients with intraventricular hemorrhage requiring placement of an intraventricular catheter for CSF drainage. They were testing the theory that low-dose TPA would assist in clot breakdown, … Continue reading “The Cure For Bleeding is More Bleeding?”
From China, in Stroke, an animal model (poor rats, as usual) of MCA ischemia, collagenase-induced ICH, and post-TPA ICH. Rats received either 0.5 mg/kg, 1.0 mg/kg, or 1.5 mg/kg ethanol after two hours of MCA occlusion. Performance on various foot, balance, and parallel behavioral testing significantly favored the ethanol treatment group with initial and sustained … Continue reading “Ethanol – Miracle Drug (For Stroke)”