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Combination Therapy for Invasive Aspergillosis in Patients with Hematologic Malignancies or Hematopoeitic Cell Transplants

In an evaluation of the primary endpoint, all-cause mortality at 6 weeks, there was no statistically significant difference between treatment with voriconazole alone or in combination with anidulafungin in patients with invasive aspergillosis and hematologic malignancies or hematopoietic stem cell transplants.

Measles in Our Not-So-Magical Kingdom

ABSTRACT & COMMENTARY: Routine vaccination would have prevented most of these recent cases in California.

Ticagrelor Cost Effective as Well as Efficacious, According to New Analysis

The PLATO trial randomized more than 18,000 acute coronary syndrome (ACS) patients to dual anti-platelet therapy with aspirin plus either clopidogrel or the newer P2Y12 inhibitor ticagrelor. Compared with clopidogrel-treated patients, those on ticagrelor had lower rates of death and myocardial infarction at 1 year. Despite superior ischemic outcomes, both ticagrelor and the thienopyridine prasugrel have been relatively slow to be adopted in the United States. This is at least in part due to the cost differential, as the older clopidogrel is available as a generic, while the newer agents enjoy continued brand exclusivity. The National Average Drug Acquisition Cost data collected by CMS currently reports a 70-fold difference in price between clopidogrel and ticagrelor.

Implantable Coronary Sinus Narrowing Device Shows Promise in Refractory Angina

Despite advances in medical therapy and in coronary revascularization techniques, the population of patients with chronic, stable, but debilitating angina continues to grow. The mortality of such patients is surprisingly low, such that patients with this disorder often suffer limiting symptoms for many years. Clearly more options for treatment are needed, but what?

Surgical Management of Infective Endocarditis

SOURCES: Chu VH, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: A prospective study from the international collaboration on endocarditis. Circulation 2015;131:131-140; Erbel R. The new strategy in infective endocarditis: Early surgery based on early diagnosis: Are we too late when early surgery is best? Circulation 2015;131:121-123.

Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes

Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.¹ To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.

Intravenous Fluids in Patients With Acute Heart Failure

MONOGRAPH: Volume overload is a hallmark of acute heart failure. In hospitalized patients, intravenous loop diuretics are the most common treatment for decongestion.

Drug Interactions and the Medical Home

MONOGRAPH: Drug-to-drug interactions are a concern of increasing significance at all levels of health care.

Internal Medicine [ALERT]

The United States Preventive Services Task Force (USPSTF) gave a level B recommendation in support of annual low-dose computed tomography (LDCT) to screen for lung cancer in appropriate risk groups. The USPSTF decision was largely based on the National Lung Screening Trial (NLST), a mega-trial (n = 53,454) in the United States that randomized subjects to annual LDCT or chest X-ray. The primary endpoint of the study was lung cancer mortality, and all-cause mortality was a secondary endpoint. Inclusion criteria included at least a 30-pack/year history of smoking (if stopped within 15 years), ability and willingness to complete follow-up for abnormal findings, and absence of problematic comorbidities that might otherwise compromise long-term survival.

Human Papillomavirus 9-valent Vaccine, Recombinant (Gardasil® 9)

The FDA has approved a 9-valent human papillomavirus (HPV) vaccine. The new vaccine covers five more types of HPV than the previous vaccine and protects against 90% of the HPV strains that cause cervical cancer.1 The new vaccine is marketed by Merck as Gardasil®9.

Internal Medicine

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