Transexamic Acid Reduces Transfusions and Mortality in Major Bleeding

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Ginecology, Hospital Procedures, medical procedures, Traumatology
More Tags – HPC updates, transexamic acid, trauma
Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-hemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots). Now…
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Direct-Acting Oral Anticoagulants Have a Lower Mortality than Warfarin for Nonvalvular Afib

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hematology, Hospital Procedures, medical procedures
More Tags – anticoagulation, atrial fibrillation, HPC updates
Compared with warfarin, the new agents significantly reduced all-cause and vascular mortality. The new direct-acting oral anticoagulants (DOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been found to be noninferior to vitamin K antagonists in clinical trials of stroke prevention in…
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Organisms That Cause Sepsis Are Changing, and Sepsis Management and Recognition Has Improved

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, Medical General, medical procedures
More Tags – HPC updates, ICU, quality care, sepsis, sepsis management, sepsis treatment
Preface: Nice summary of the changing pathogenic organisms causing severe sepsis.  This summary also displays how improved sepsis recognition and management has decreased mortality from 40% to 28% over the last decade. Mortality decreased from 40% to 28% overall. Although…
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New Study Suggests Continued Statin Use After ICH Improves Outcomes

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures, Neurological diseases
More Tags – HPC updates, ICU Quality Care, Intracerebral Hemorrhage, intracranial hemorrhage, Statins
Preface: The SPARCL trial made clinicians wary that high-dose statins may increase the risk of intracranial hemorrhage (ICH). This new observational study suggests that continued statin use after ICH appears to improve outcomes. The SPARCL trial (Stroke Prevention through Aggressive Reduction…
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New Study Identifies 7 Interventions to Decrease 30-day Readmission Rates

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Medical General, medical procedures
More Tags – HPC updates, ICU, quality care, readmission rates, self-care, study
Preface: New study identifies 7 interventions to decrease the 30-day readmission rates.  The most effective interventions involved case workers and Improving patients ability to provide self-care at home. Study design: Meta-analysis. Setting: Forty-seven studies in multiple locations. Synopsis: This study evaluated…
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High risk for postoperative adverse cardiovascular events during the first 9 months after stroke

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Events, Hospital Procedures, medical procedures
More Tags – adverse cardiovascular events, cardiovascular, HPC updates, ischemic stroke
Risk for postoperative adverse cardiovascular events was especially high during the first 9 months after stroke. If possible, you should wait at least 9 months and preferably 12 months after an ischemic stroke to undergo elective non cardiac surgery. Stroke…
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Catheter-directed thrombolysis for DVT potentially has equivalent mortality rates when compared with systemic anticoagulation alone.

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Hospital Procedures, medical procedures
More Tags – catheter-directed thrombolysis, Deep vein thrombosis, HPC updates, post-thrombotic syndrome
Previous trials have shown that catheter-directed thrombolysis (CDT) for proximal deep vein thrombosis has a lower rate of post-thrombotic syndrome compared with systemic anticoagulation alone.  However, a new retrospective cohort study shows that the mortality rates are equivalent and the rates of transfusion,…
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Antiretroviral therapy recommended for all HIV-infected patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – antiretroviral, antiretroviral therapy, antiretroviral treatment, antiviral, antiviral society, HIV, HPC updates, infection
New guidelines from the International Antiviral Society recommend antiretroviral therapy for ALL HIV-infected patients Sponsoring Organization: International Antiviral Society–USA (IAS-USA) Target Population: Clinicians who treat HIV-infected patients Key Recommendations Antiretroviral therapy (ART) is recommended for all HIV-infected patients, including those with acute HIV infection—but…
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Assessment, Diagnosis, and Management of Childhood Concussions

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Neurological diseases, Traumatology
More Tags – childhood concussion, concussion, head trauma, HPC updates
Sponsoring Organization: Ontario Neurotrauma Foundation Target Population: Healthcare professionals and others who deal with concussion, including physicians, neuropsychologists, physical therapists, family, and schools/community sports organizations Background and Objective The panel used an evidence-based, systematic review to standardize diagnosis, assessment, and management of…
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Early Goal Directed Therapy for Sepsis: No Longer?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central line, Hospital Procedures, Infections, medical procedures
More Tags – Central Line; Central Venous Catheter; Septic Shock; Sepsis; Early Goal Directed Therapy; ProCESS, HPC updates
In 2001, the Rivers trial showed that Early Goal Directed Therapy for septic shock resulted in a 16% absolute mortality risk reduction1. In the treatment arm of this trial, septic patients with a lactate above 4 mmol/L or systolic blood…
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MRI is useful to distinguish between residual clot versus acute recurrent DVT

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hematology, Hospital Procedures, medical procedures
More Tags – compression ultrasound, D-dimer, DVT, HPC updates, MRI
Frequently the combination of a serum D-dimer level and compression ultrasound testing can differentiate between a residual venous clot and an acute recurrent DVT.  However, sometimes the results are equivocal and in these situations an MRI direct thrombus imaging can…
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Azithromycin to prevent COPD Exacerbations or not?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, medical procedures, Respiratory diseases
More Tags – COPD, COPD exacerbations, HPC updates
This is a nice review on azithromycin to prevent chronic obstructive pulmonary disease exacerbations (COPD exacerbations). A recent Cochrane analysis and a retrospective VA study were both found that continuous azithromycin use decreased the incidence of COPD exacerbations in patients…
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