JournalTOCs

Clinical Medicine Insights : Trauma and Intensive Medicine
Number of Followers: 3

This is an Open Access Journal

Open Access journal
ISSN (Print) 1179-5603
Published by Sage Publications

[1176 journals]

Evaluation of the Use of Argatroban or Bivalirudin for the Management of
Suspected Heparin-Induced Thrombocytopenia in the Setting of Continuous
Renal Replacement Therapy
- Authors: Tyler Chanas, Surabhi Palkimas, Hillary S Maitland, Amanda Liszewski
  Abstract: Clinical Medicine Insights: Trauma and Intensive Medicine, Volume 10, Issue , January-December 2019.
  Studies have shown an association between continuous renal replacement therapy (CRRT) and thrombocytopenia. Patients on CRRT usually receive unfractionated heparin (UFH), and heparin-induced thrombocytopenia (HIT) is frequently suspected as a potential cause of thrombocytopenia. In the setting of HIT suspicion, changes in anticoagulation may put patients at risk of developing thromboembolic events or adverse medication effects.Purpose:The purpose of this study was to investigate current management of anticoagulation in patients with suspected HIT while on CRRT and identify complications associated with anticoagulation in this setting.Methods:This is a retrospective study of patients on CRRT with suspicion for HIT. Prevalence of HIT and anticoagulant use were collected for all patients. Outcomes included thromboembolic and bleeding events, final therapeutic doses of each anticoagulant, and time to reach therapeutic range. Thromboembolic and bleeding outcomes were compared between anticoagulants.Results:From January 2013 through December 2015, 74 patients were identified with suspicion of HIT while on CRRT. During the period of HIT suspicion, 20 patients received argatroban, 18 received bivalirudin, 1 received fondaparinux, 4 received UFH infusions, 10 received prophylactic dosing subcutaneous UFH, and 21 received no anticoagulation. The median final therapeutic doses of argatroban and bivalirudin were 1.00 μg/kg/min and 0.075 mg/kg/h, respectively, with no difference in time to therapeutic range (17.6 h vs 18.2 h, P = .485). Compared with bivalirudin, patients treated with argatroban had significantly more therapeutic activated partial thromboplastin time (aPTT) values (54.5% vs 42.8%, P = .008). Four patients (20.0%) treated with argatroban and 5 patients (27.8%) treated with bivalirudin experienced major bleeding (P = .709). Three patients (15.0%) treated with argatroban and 4 patients (22.2%) treated with bivalirudin experienced thromboembolic events (P = .687).Conclusion:Argatroban and bivalirudin were associated with similar rates of bleeding and thromboembolic events during the period of concurrent CRRT and thrombocytopenia, although patients treated with argatroban had more therapeutic aPTT values.
  Citation: Clinical Medicine Insights: Trauma and Intensive Medicine
  PubDate: 2019-05-01T11:56:43Z
  DOI: 10.1177/1179560319846452
  Issue No: Vol. 10 (2019)
Agreement and Correlation of Arterial and Venous Blood Gas Analysis in a
Diverse Population
- Authors: Paul A Chung, Anthony Scavone, Asrar Ahmed, Kristine Kuchta, Shashi K Bellam
  Abstract: Clinical Medicine Insights: Trauma and Intensive Medicine, Volume 10, Issue , January-December 2019.
  Introduction:Agreement and correlation of arterial blood gases (ABGs) and venous blood gases (VBGs) at near normal values are well described but have not been well validated at extremes of values. We evaluated the agreement and correlation of ABG and VBG at extremes of values and assessed the utility of VBG as a screening tool.Methods:We performed a retrospective, observational study of ABG and VBG collected at the same time. Statistical analysis included Bland-Altman plot analysis, Pearson correlations, and sensitivity/specificity tests. For limits of agreement (LOA), we set a threshold of ±0.10 units for pH and ±2.4 mm Hg for partial pressure of carbon dioxide (pCO2). A threshold of 80% sensitivity was considered appropriate for VBG to be used as a screening tool for abnormal ABG values.Results:There were 1684, 1744, and 1769 paired pH, pCO2, and HCO3¯ results, respectively. Mean difference (MD) for arterial and venous pH was 0.017 (95% confidence interval [CI]: 0.014-0.020; 95% LOA: −0.11 to 0.15), and Pearson correlation was 0.78 (P
  Citation: Clinical Medicine Insights: Trauma and Intensive Medicine
  PubDate: 2019-05-01T11:53:23Z
  DOI: 10.1177/1179560319845869
  Issue No: Vol. 10 (2019)
Does the Use of Magnetic Resonance Imaging Scan in Occult and Suspected
Metastatic Pathological Neck of Femur Fractures Affect the Choice of
Surgical Intervention'
- Authors: Basil Budair, Mohammad Al-Tibi, Tarek Boutefnouchet
  Abstract: Clinical Medicine Insights: Trauma and Intensive Medicine, Volume 10, Issue , January-December 2019.
  Background:Magnetic resonance imaging (MRI) is often employed as the diagnostic modality of choice in occult and suspected pathological femoral neck fractures. We evaluated the clinical utility of MRI scan in this patient population.Method:Retrospective observational analysis of cases with a radiologically occult or suspected metastatic pathological neck of femur fracture.Results:From a total of 894 femoral neck fractures treated in our institution, 100 patients had and MRI scan pre-operatively for either occult fracture or suspected fracture secondary metastatic disease. Magnetic resonance imaging confirmed the presence of 13 simple fractures. A total of 14 patients had pathological features suggestive of metastasis, of which 12 were clearly visible on plain radiographs. Surgical plan did not change after MRI for any of these pathological fractures.Conclusion:Results of this study demonstrate that an MRI scan had an impact on treatment selection only when a simple but radiographically occult fracture is suspected and but not in the context of suspected metastatic pathological fractures.
  Citation: Clinical Medicine Insights: Trauma and Intensive Medicine
  PubDate: 2019-04-30T09:48:09Z
  DOI: 10.1177/1179560319843286
  Issue No: Vol. 10 (2019)

HOME > Browse the 73 Subjects covered by JournalTOCs
Subject	Total Journals