In this trial of patients on warfarin undergoing a pacer/ICD procedure, they were randomized to continue warfarin perioperatively, or receive heparin bridge therapy. The study was stopped early when the heparin group suffered 4 times more device pocket hematomas than the warfarin group. Based on this well done trial, warfarin should be continued perioperatively in patients undergoing pacers/ICDs (abstract).
The FDA just approved a prothrombin complex concentrate (Kcentra) to reversal bleeding associated with vitamin K antagonists. It does not require thawing or blood type matching, unlike plasma, but it does carry a black box warning for risk of clotting (arterial and venous) (FDA site).
This large population based cohort found current use of steroids increased the risk of VTE by a factor of 2-3, depending on the timing and dosage. Steroids should be factored in when determining VTE risk (abstract).
In this single center study, lactate levels >2 were significantly associated with risk of death at 30 days (mortality of 17% in those with levels >2 versus 2% in those with levels <2 mmol/L); overall the lactate level was significantly associated with 30 day mortality (with a hazard ratio of 11.7). Lactate may be a good prognostic marker for mortality in patients with PE (abstract).
This large single center retrospective cohort of ~700 patients who had retrievable IVC filters placed, found only 9% were successfully removed, 18% were attempted to be removed and failed, and 8% suffered a subsequent thrombotic event despite the IVC. Although this study may not reflect practice at other institutions (eg successful and unsuccessful retrieval rates), it does raise concerns about the risks and benefits of IVC filter placements (abstract).