The Annals of pharmacotherapy
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Comparative Study Clinical Trial
Accuracy, clinical correlation, and patient acceptance of two handheld prothrombin time monitoring devices in the ambulatory setting.
To evaluate the accuracy, clinical correlation, ease of use, and patient acceptance of the Coaguchek and the ProTime Microcoagulation System as compared with standard laboratory methods for prothrombin time determination. ⋯ The Coaguchek was superior to the ProTime Microcoagulation System in accuracy, clinical correlation, and ease of use. The study also showed that patients preferred capillary blood sampling by finger puncture over venipuncture for INR monitoring.
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Case Reports
Use of intravenous valproate in three pediatric patients with nonconvulsive or convulsive status epilepticus.
To report the pharmacokinetics of intravenous valproate (VPA) in children with generalized convulsive status epilepticus (GCSE) or nonconvulsive status epilepticus (NCSE). To provide loading and maintenance dosing for patients with hepatic induction secondary to concurrent anticonvulsants. ⋯ A 20 mg/kg loading dose should produce a concentration after the bolus dose of approximately 75 mg/L. Initial infusion should consider hepatic induction (noninduced = 1 mg/kg/h, polyanticonvulsant therapy = 2 mg/kg/h, and high-dose pentobarbital = 4 mg/kg/h). Adjustments should be based on response and serum concentrations.
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To report an unusual reaction associated with weekly administration of paclitaxel. ⋯ Onycholysis is an uncommon reaction that may occur in some patients receiving weekly, low-dose paclitaxel therapy. The reaction is not life-threatening and does not warrant discontinuation of therapy. However, clinicians should be aware of the possibility of this effect and be prepared to advise patients who develop signs of nail changes.
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Review Comparative Study
Streptokinase and urokinase for the treatment of pleural effusions and empyemas.
It is evident from these studies that thrombolytics significantly increase the amount of drainage from pleural effusions or empyemas. The effect on other outcome measures, such as length of hospital stay, days before defervescence, days with chest tube, surgical procedures, and mortality is questionable. The lack of randomized, controlled trials comparing streptokinase and urokinase makes a true comparison rather difficult. ⋯ In conclusion, urokinase offers no significant benefits over streptokinase. The incidence of fever was greater in one comparative trial with streptokinase than with urokinase. Based on cost considerations and lack of comparative studies, urokinase infusions should be reserved for patients who develop fever when receiving continued therapy with streptokinase.
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Letter Case Reports
Potentiation of the acenocoumarol anticoagulant effect by acetaminophen.