Archive for September 2012

Vaptins should not be used in hyponatremia in cirrhosis

This systematic review of clinical trials of the use of vaptans (tolvaptan, satavaptan, and lixivaptan) in patients with cirrhosis and hyponatremia found no difference in mortality, variceal bleeding, hepatic encephalopathy, SBP, hepatorenal syndrome, or renal failure, compared to placebo. The use of vaptans did increase serum sodium and reduced weight, but also increased the risk of adverse events. The weight of evidence does not support the use of vaptans in cirrhotics with hyponatremia (abstract).

TKA volume markedly increased

In this large observational cohort of Medicare patients, the volume of total knee arthroplasty (TKA) increased 162% from 1991 to 2010, while revisions increased 106%. Length of stay dropped from 7.9 to 3.5 days, and 30 day readmissions increased from 4.2% to 5.0%. These increases bode well for hospitalist co-management services (abstract)

Bleeding with drug combinations in patients with CAD and Afib

In patients with Afib and CAD requiring anti platelet therapy, optimal anticoagulation is unknown. In this cohort, bleeding rates were 14/100 person years with triple therapy (warfarin + 2 anti platelets), ~7-11/100 person years for any dual therapies, and ~6-7/100 person years for any mono therapy. Compared to dual therapy, triple therapy was not associated with a reduction in the combined outcome of CV death, MI, stroke. Triple therapy increases bleeding, without apparent benefit, in patients with Afib and CAD (abstract)

No benefit to newer oral anticoagulants after ACS

In this systematic review of patients post-ACS on anti platelet therapy, the use of newer oral anticoagulants (rivaroxaban, apixaban, dabigatran) was associated with much higher risk of bleeding (odd ratio 3, CI 2.2 to 4.2), a moderate reduction in stent thrombosis/ischemia, and no overall change in mortality, compared to placebo. The overall net benefit of these agents was no different than placebo. The new oral anticoagulants do not appear to benefit patients post-ACS (abstract).

Healthcare workers decline flu vaccinces

According to a survey by the CDC, 86% of physicians and 78% of nurses received a flu vaccine during last flu season. Vaccine rates were 95% among healthcare workers in hospitals that required the vaccine. The most common reasons cited for not getting vaccinated included the belief that it was not necessary, and concerns about efficacy and side effects. All hospitalists should get annual flu vaccination unless contraindicated (CDC site)