Archive for August 2011

Colchicine reduced recurrent pericarditis

In this trial of 120 patients with their first recurrence of pericarditis, they were randomized to colchicine (0.5-1.0 mg a day) or placebo; the risk of recurrence was reduced by 56% (from 55% in the placebo group to 24% in the colchicine group at 6 months) with a number needed to treat of 3. Side effects and drug withdrawals were similar. Colchicine is safe and effective for reducing recurrence rates of colchicine (abstract)

Apixaban superior to warfarin for stroke prevention

In this randomized trial of >18,000 patients with atrial fibrillation, apixaban was superior to warfarin for the primary outcome of stoke or embolism (1.3% vs 1.6%, 32% relative risk reduction), as well as for major bleeding (2.1% vs 3.1%), death (3.5% vs 3.9%) or hemorrhagic stroke (.24% vs .47%). As soon as FDA approved, apixaban will join dabigatran in the arsenal of oral agents safe and effective for Afib-related stroke prevention (abstract)

Patient acuity rating predicts clinical deterioration

This single center prospective cohort found that a 7-point patient acuity rating completed at the time of sign out was a good predictor of clinical deterioration (eg cardiac arrest or ICU transfer) within 24 hours. The predictive capacity was better for attendings than housestaff. This simple rating scale can aid cross-cover prioritization and decision making, especially in light of the number of hand-offs in academic medical centers (abstract)

USG better than Chest Xray in intubated ICU patients

In this small single center diagnostic study in intubated ICU patients, the use of portable was more sensitive in diagnosing consolidation, pneumothorax, pleural effusion, and interstitial syndromes than was chest xray. Portable USG may be more useful than chest xrays in diagnosing lung pathology in intubated patients. (abstract)

IV enoxaparin at least as effective, and just as safe as unfractionated heparin for patients undergoing PCI

In this industry-sponsored trial, patients with STEMI were randomized before PCI to get standard dosing unfractionated heparin or 0.5mg/kg of IV lovenox. There were no significant differences between the groups in the primary outcome (death, complication, procedure failure, or bleeding), but enoxaparin preformed better than heparin in the secondary outcome (death, recurrent ACS, urgent revasularization). Given the ease of administration and predictable dose-response, IV lovenox may be appealing for STEMI before PCI, although cost is higher (abstract)