Cardiology
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Earlier Coronary Artery Bypass Grafting After Ticagrelor Discontinuation Is Safe
In a trial that included acute coronary syndrome patients treated with ticagrelor, undergoing coronary bypass surgery within two to three days was noninferior to the guideline-recommended five to seven days regarding severe bleeding.
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Pharmacotherapy for Atrial Fibrillation with Anticoagulation-Associated Intracranial Hemorrhage
A study of apixaban vs. no anticoagulation in patients following an anticoagulant for atrial fibrillation-related intracerebral hemorrhage exhibited a high risk of stroke and vascular death, regardless of whether the patients were treated subsequently with apixaban.
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Role of Beta-Blockers in Heart Failure with Preserved Ejection Fraction
Discontinuation of beta-blockers in heart failure with preserved ejection fraction patients significantly improved quality of life scores and expanded exercise capacity.
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ED Plays ‘Central Role’ in STEMI Care
This includes prehospital cath lab activation, knowing when it is appropriate to bypass the ED, understanding the sequence of events for patients presenting to the ED, knowing what to do to shorten ED dwell time, and knowing what is best to do if awaiting cath lab arrival.
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Effective Defense for ED if Allegation Is Failure to Rule Out Aortic Dissection
Aortic dissection is not an easy diagnosis to make, and providers cannot order advanced imaging on every person who comes through the ED. But the mere act of documenting why aortic dissection was thought to be unlikely could make the provider reconsider the decision to discharge — and end up saving a life.
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Is This Wellens’ Syndrome?
The ECG in the figure is from a young adult man known to have a bicuspid aortic valve. He presented to the ED following a presyncopal episode. The patient has not experienced chest pain recently. Does this patient have Wellens’ syndrome?
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Varenicline Nasal Spray (Tyrvaya)
Varenicline nasal spray is indicated to treat the signs and symptoms of dry eye disease.
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Intensive Blood Pressure Lowering Does Not Affect Small Vessel Disease Progression
Intensive blood pressure lowering was not associated with worsening but did not demonstrate any benefit in this population over standard blood pressure management.
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Environmental Shedding of MRSA Far Greater Than From Multidrug-Resistant Gram-Negative Bacilli
An observational cohort study showed shedding of methicillin-resistant Staphylococcus aureus by colonized patients outside hospital rooms or during outpatient clinic visits occurred more often than in those colonized by multidrug-resistant gram-negative bacilli.
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COVID-19 Vaccination, Pregnancy, Lactation, and Fertility
Vaccination rates are notably low among pregnant women. Clinicians should underscore the safety of vaccination and the risks of natural infection, particularly in pregnancy and in patients with underlying comorbidities.