BackgroundFollowing heart transplantation (HT), HMG CoA reductase inhibitors (statins) have been shown to reduce total and low‐density lipoprotein (LDL) cholesterol, development of cardiac allograft vasculopathy (CAV), and mortality. Studies in HT patients have demonstrated the safety of low/moderate intensity statins; however, little data exist using high‐intensity (HI) statins. The study aim was to evaluate the safety and efficacy of HI statins in HT recipients receiving tacrolimus.MethodsThis single‐center, retrospective analysis included adult HT recipients from January 1, 2005, to December 31, 2015, who received HI statin therapy during posttransplant follow‐up. The primary outcome, tolerability, was defined as the absence of myalgias, hepatotoxicity, rhabdomyolysis, or HI statin dose reduction/discontinuation. The secondary end point was the mean reduction in total and LDL cholesterol.ResultsAmong the 24 patients included, one experienced myalgias and therapy discontinuation (4%; P > 0.99). No other HI statin dose reduction/discontinuation occurred, and no instances of rhabdomyolysis or hepatotoxicity were observed. The average reduction in total and LDL cholesterol after conversion to HI statin was 35 mg/dL (P = 0.02) and 19 mg/dL (P = 0.10), respectively.ConclusionsHigh‐intensity statin therapy appears safe and efficacious in HT recipients receiving tacrolimus and is a reasonable option for the treatment of refractory hyperlipidemia.
We show that spironolactone use was associated with an increased rate of all-cause hospitalizations, but no difference in hospitalizations for heart failure or pulmonary arterial hypertension, in patients with World Health Organization Group 1 pulmonary arterial hypertension. A possible reason for this finding is confounding from retrospective study design.
Background
Studies have demonstrated equal efficacy between meropenem 500 mg intravenously every 6 hours and 1000 mg intravenously every 8 hours. Few critically ill patients were included in these studies, and theoretical pharmacokinetic and pharmacodynamic concerns exist with the more conservative dosing regimen. We sought to compare the efficacy of these 2 dosing regimens in septic patients at our institution.
Methods
A retrospective, single-center, cohort study was performed comparing 2 meropenem dosing regimens in septic patients admitted to 5 intensive care units at the University of North Carolina Medical Center. The primary outcome was rate of clinical success at 7, 10, and 14 days. Secondary outcomes included time to clinical success, rate of microbiologic failure, in-hospital mortality, meropenem-related mortality, and intensive care units and hospital length of stay.
Results
One hundred seventeen patients meeting inclusion and exclusion criteria were analyzed. Clinical success at 7 (69% vs 81.8%; P = 0.163), 10 (76.2% vs 84.8%; P = 0.403), and 14 days (84.5% vs 87.9%; P = 0.591) did not differ significantly between the meropenem 500 mg and 1000 mg groups, respectively. There were higher rates of in-hospital (29.6% vs 14.2%, P = 0.290) and meropenem-related mortality (10.7% vs 6.1%; P = 0.792) and microbiological failure (4.2% vs 0%; P = 0.269) in patients in the 500 mg group.
Conclusions
There was not a statistically significant difference in rates of clinical success at 7, 10, and 14 days in septic patients in the meropenem 500 mg group compared with the 1000 mg group. Caution should be used when extrapolating the more conservative dosing strategy to critically ill patients. A larger, matched retrospective analysis or prospective study would be beneficial in determining if these dosing regimens can be used interchangeably in this population.
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