Summary The reported incidence rate of venous and arterial thrombotic events in critically ill patients with COVID‐19 infections is high, ranging from 20% to 60%. We adopted a patient‐tailored thromboprophylaxis protocol based on clinical and laboratory presentations for these patients in our institution. We hypothesised that patients who received high‐intensity thromboprophylaxis treatment would experience fewer thrombotic events. The aims of our study were to explore the incidence of thrombotic events in this population; to assess independent factors associated with thrombotic events and to evaluate the incidence of haemorrhagic events. A retrospective review of all adult patients with confirmed SARS‐CoV‐2 infection admitted to the intensive care unit (ICU) between 1 March and 29 May 2020 was performed. The primary outcome was a composite of venous and arterial thrombotic events diagnosed during the ICU stay. Multivariable logistic regression was used to identify the independent factors associated with thrombotic events. A total of 188 patients met the inclusion criteria. All received some type of thromboprophylaxis treatment except for six patients who did not receive any prophylaxis. Of the 182 patients who received thromboprophylaxis, 75 (40%) received high‐intensity thromboprophylaxis and 24 (12.8%) were treated with therapeutic anticoagulation. Twenty‐one patients (11.2%) experienced 23 thrombotic events (incidence rate of 12.2% (95%CI 7.9–17.8)), including 12 deep venous thromboses, 9 pulmonary emboli and 2 peripheral arterial thromboses. The multivariable logistic regression analysis showed that only D‐dimer (OR 2.80, p = 0.002) and high‐intensity thromboprophylaxis regimen (OR 0.20, p = 0.01) were independently associated with thrombotic events. Thirty‐one patients (16.5%) experienced haemorrhagic events; among them, 13 were classified as major bleeding according to the International Society on Thrombosis and Haemostasis criteria. Therapeutic anticoagulation, but not the high‐intensity thromboprophylaxis regimen, was associated with major bleeding. A proactive approach to the management of thromboembolism in critically ill COVID‐19 patients utilising a high‐intensity thromboprophylaxis regimen in appropriately selected patients may result in lower thrombotic events without increasing the risk of bleeding.
BackgroundClinical effects and outcomes of a single dose etomidate prior to intubation in the intensive care setting is controversial. The aim of this study is to evaluate the association of a single dose effect of etomidate prior to intubation on the mortality of septic cirrhotic patients and the impact of the subsequent use of low dose hydrocortisone.MethodsThis is a nested-cohort study within a randomized double blind placebo controlled study evaluating the use of low dose hydrocortisone in cirrhotic septic patients. Cirrhotic septic patients ≥ 18 years were included in the study. Patients who received etomidate prior to intubation were compared to those who did not receive etomidate for all cause 28-day mortality as a primary outcome.ResultsSixty two intubated patients out of the 75 patients randomized in the initial trial were eligible for this study. Twenty three of the 62 intubated patients received etomidate dose prior to intubation. Etomidate use was not associated with all cause 28-day mortality or hospital mortality but was associated with significantly higher ICU mortality (91% vs. 64% for etomidate and controls groups, respectively; p = 0.02). Etomidate patients who received subsequent doses of hydrocortisone required lower doses of vasopressors and had more vasopressor-free days but no improvement in mortality.ConclusionsIn this group of septic cirrhotic patients with very high mortality, etomidate increased ICU mortality. Subsequent use of hydrocortisone appears to have no benefit beyond decreasing vasopressor requirements. The lowest mortality was observed in patients who did not receive etomidate but received hydrocortisone.
BackgroundHeart failure (HF) patients derive a dose‐dependent clinical benefit from medications that are part of guideline‐directed medical therapy (GDMT). The widespread underdosing of these medications and the clinical implications of the lack of titration have been well documented. There is paucity of data on design and outcomes of pharmacist‐led HF clinics.AimThe aim of this study is to describe the establishment of the first pharmacist‐led HF pharmacotherapy clinic (HFPC) in the Middle East gulf region.MethodsThis is a retrospective study of patients seen by the HF pharmacotherapy clinic. We determined the percentage of patients on target doses of GDMT at baseline and at the end of follow‐up in the subgroup of patients with HF with reduced ejection fraction (HFrEF). All baseline self‐care behaviors and interventions performed were examined.ResultsThe first 100 patient referrals and 193 visits were included in this analysis for an average of 1.9 ± 1.4 visits per patient and a mean follow‐up period of 51 ± 36.1 days. Most patients (94%) had HFrEF and were referred to from the outpatient clinics (72%). Many patients (76%) had at least one inadequacy in medication adherence or self‐care behaviors at baseline, and none were on simultaneous target doses of all GDMTs. At the end of follow‐up, more patients with HFrEF were on target doses when compared with baseline (beta‐blockers 31.9% vs 40.4%, P = .032, angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin II receptor blocker neprilysin inhibitor 7.4% vs 25.5%, P < .001, mineralocorticoid receptor antagonist 37.2% vs 39.4% P = .46, all three target GDMTs 0% vs 6.4%, P = .093). Significantly, more patients were on any dose of all three GDMTs.ConclusionsPharmacist‐led HF medication optimization clinic establishment can contribute to longitudinal medication titration, successful transition of care, and correcting noncompliance and indiscretions. Pharmacists are in an ideal position to fill gaps and help evolve the current HF care model.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.