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In this issue: Some women with DVT may stop warfarin after six months; Vytorin and cancer; preventing recurrent stroke; and FDA news.
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Regardless of where we practice, increasingly we are confronted with patients who have been exposed to unusual diseases through travel. In a previous series of articles, we reviewed the diseases associated with travel, largely based on the geography. This article reviews infectious disease associated with travel by symptoms.
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Although anemia was predictive of adverse outcomes in patients with aneurysmal subarachnoid hemorrhage, red blood cell transfusion was also associated with an increased risk of death, severe disability or delayed infarction. These results call into question the practice of liberal transfusion thresholds in patients with spontaneous subarachnoid hemorrhage.
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In spite of institutional education regarding appropriate use of prophylactic antibiotics, compliance was achieved only when hospital protocols that mandated specific antibiotic use were implemented.
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The optimal duration of oral anticoagulation therapy after an initial symptomatic deep venous thrombosis remains unknown. Siragusa et al assessed patients by ultrasonography for the presence of residual vein thrombosis (RVT) after three months of anticoagulation for a DVT. Those with RVT were randomized to 9 additional months of anticoagulation versus discontinuation. Among the 70% with RVT, prolonged anticoagulation showed only a non-significant trend for reducing recurrent DVT. For the 30% without RVT, all of whom stopped anticoagulation after three months, only one of 78 patients (1.3%) developed a recurrent DVT. For select patients, the lack of RVT after initial anticoagulation identifies patients in whom anticoagulation may be safely discontinued. The optimal duration of anticoagulation for higher risk patients, including those with RVT, remains undefined.
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Blockage of the harmful effects of tissue plasminogen activator by imatinib (Gleevec) might improve ischemic stroke outcomes.
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Although the ECG is key in the triage of suspected ST wave elevation myocardial infarction (STEMI), it is imperfect.
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