American journal of therapeutics
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Perioperative management of patients on chronic anticoagulant use involves balancing individual risk for thromboembolism and bleeding. Discontinuation of antithrombotic therapy can place patients at increased risk of thromboembolic complications, whereas continuing antithrombotic therapy can increase procedure-related bleeding risk. Temporary perioperative substitution of low-molecular weight heparin or unfractionated heparin in place of warfarin, "the bridge therapy" is often used in the periprocedural period, but the indications and timing of this is still uncertain. This review addresses the risk stratification of patients according to thromboembolic risk, indications, timing, and duration, and a practical approach to bridge therapy.
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Thirty-six million Americans older than 12 years of age have used cocaine in their lifetime. Cocaine abuse is on the rise and it brings the challenges to treat the complication associated with it, particularly cardiovascular complications. As the understanding of pathophysiology of cocaine-associated cardiovascular complications is advancing, the treatment modalities are also modifying. In this article, common cardiovascular complications associated with acute or chronic cocaine use and their treatment are reviewed.
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Shoulder pain following thoracotomy is a common postoperative complaint and can be difficult to treat. This article explores how to select patients who would benefit from a suprascapular nerve block for post-thoracotomy shoulder pain. A retrospective case review of 178 patients who underwent thoracotomy at our institution was performed. ⋯ Twenty-nine of 34 (85.3%) patients obtained satisfactory pain relief. We estimate a true-positive rate of 85.3% with a 95% confidence interval of (68.9%, 95.0%) for those patients who received relief from suprascapular nerve block after localizing signs on physical examination of the shoulder. Patients post-thoracotomy with local signs of shoulder pain on physical examination may benefit from suprascapular nerve blocks in the immediate postoperative period.
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Venous thromboembolic disease, including deep vein thrombosis and pulmonary embolism, is a cause of significant mortality and morbidity. For several decades, anticoagulant options for the treatment and prevention of thrombosis have been limited mainly to agents such as unfractionated heparin and oral vitamin K antagonists, such as warfarin. ⋯ Specifically, progress has been made in the development of small molecule factor Xa inhibitors and thrombin inhibitors. With their potentially consistent and predictable clinical profile, oral formulation, and decreased need for coagulation monitoring, these new agents will likely increase the use and duration of anticoagulation treatment in thromboembolic disorders and reduce the burden associated with long-term management.
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Comparative Study
Comparison of short-acting intramuscular antipsychotic medication: impact on length of stay and cost.
A retrospective cohort study was conducted to determine if there is an association between short-acting intramuscular (SAIM) antipsychotics used for acute agitation and length of stay (LOS). Patients with a diagnosis of schizophrenia or schizoaffective disorder who were dispensed at least one dose of a SAIM antipsychotic were divided into groups based on the initial SAIM antipsychotic received once admitted to a psychiatric unit. Electronic records were used to gather demographic information, LOS, and number of injections received during an admission. ⋯ Patient characteristics should be evaluated when determining an agent for acute agitation. However, because literature indicates second generation SAIM antipsychotics are only noninferior to haloperidol; other factors should also be evaluated; including impact on LOS and impact on hospital resources. This study indicates use of a second generation SAIM antipsychotic for acute agitation is more costly, requires more injections, and was not associated with a shorter length of stay when compared with SAIM haloperidol.