Published in the March 2008 issue of Today’s Hospitalist
Stopping clopidogrel may trigger adverse events
PATIENTS WITH acute coronary syndrome treated post-discharge with clopidogrel were found to run significantly higher risk of adverse events in the first 90 days after they stopped the therapy.
The retrospective study looked at more than 3,100 VA hospital patients discharged between October 2003 and March 2005. Researchers followed both ACS patients who had been medically treated and those who had received percutaneous coronary intervention.
During follow-up, the study found that in medically treated patients who experienced death or acute myocardial infarction after stopping clopidogrel, 60.8% of those events occurred within 90 days of clopidogrel cessation. (In PCI patients, the 90-day adverse event rate among patients experiencing those vents was 58.9%.)
Authors concluded that more research is needed to confirm the clustering of adverse events after clopidogrel cessation and to identify strategies to counteract those effects.
The study was published in the Feb. 6 Journal of the American Medical Association.
More evidence of problems with night, weekend care
A NEW STUDY has found that survival-to-discharge rates for patients who have in-hospital cardiac arrest are substantially poorer if arrest occurs at night or on the weekend. The study joins several others that have detailed care problems for inpatients during those times.
Researchers evaluated survival rates from January 2000 to February 2007 for more than 86,000 patients who suffered in-hospital arrest. The study found that the rate of survival to discharge for patients who arrested on the weekend or at night was 14.7% vs. 19.8% for day-time arrests.
Survival at 24 hours was 28.9% vs. 35.4%, while the rate of favorable neurological outcomes was 11% vs. 15.2%. Survival during weekday days and evenings was higher (20.6%) vs. the rate on weekends (17.4%). Researchers found that worse outcomes occurred at night and on weekends in monitored ICUs as well as in non-ICU settings, although monitoring did seem to mitigate differences found during day/evening vs. night/weekend outcomes. The only inpatient settings that did not have worse survival rates at night were trauma services and the ED.
Researchers concluded that part of those differences may be biological. They pointed, however, to staffing and other operational factors, and said findings highlight the need for targeted resuscitation processes during those times. Authors also recommended additional training in cardiac resuscitation for providers working at night.
The study was published in the Feb. 20 issue of Journal of the American Medical Association.
Boot Camp 101 for Hospitalists
North Shore University Hospital
March 20, 2008
Johns Hopkins Consultative Medicine Essentials
Johns Hopkins University
School of Medicine
Hospital Medicine 2008
Society of Hospital Medicine
April 3-5, 2008
National Procedures Institute
Various dates and locations
Internal Medicine 2008
American College of Physicians
May 15-17, 2008
New recommendations on heparin dosing
THE FDA IS CALLING on physicians to use lower doses and slower infusions of heparin instead of bolus dosing. The recommendation came after the manufacturer of half the nation’s supply of heparin temporarily suspended production of multi-dose vials in the wake of reports of deaths and other reactions.
Most of the serious events took place at dialysis centers, although cases have been reported in hospitals with heart surgery patients. To help avoid a national shortage, the manufacturer “Baxter Healthcare “is not recalling multi-dose vials.
The FDA made the following recommendations:
- give heparin as an IV infusion instead of a bolus dose;
- use the lowest possible dose at the slowest infusion rate;
- monitor patients for adverse events, particularly hypotension and hypersensitivity; and
- consider pre-treating patients with corticosteroids or antihistamines.
More information is online at www.fda.gov
Low marks for rates of VTE prophylaxis
WHILE A RECENT INTERNATIONAL STUDY found that half of all hospital patients are at risk of developing venous thromboembolism (VTE), many of those patients do not receive prophylaxis.
As part of the study, researchers assessed the VTE risk of more than 68,000 patients across 32 countries. Among those patients, 55% were medical and 45% were surgical.
The following were among the findings of the study, which was published in the Feb. 2 issue of The Lancet:
- Among medical patients, 41.5% were judged to be at risk for VTE. The risk rate among surgical patients was 64.4%.
- Only 39.5% of at-risk medical patients received prophylaxis; among at-risk surgical patients, the prophylaxis rate was 58.5%.
- Germany had the highest prophylaxis rates among countries studied. Rates in the U.S. for receiving any form of prophylaxis were 64% for at-risk medical patients and 80% for at-risk surgical patients.
Online Survey: A snapshot of new services
Does your program plan to add a new service in the next six months?
Which service is your group planning to add?
Surgical or periop management: 22.2%
Pre-op clinic: 11.1%
Procedures service: 0%
Addiction medicine: 66.7%
Why is your group adding the service?
Administration request: 37.5%
Referring physician request: 12.5%
Hospitalist initiative: 50%
Which service does your group already offer?
Surgical or periop management: 11.1%
Pre-op clinic: 22.2%
Procedures service: 11.1%
Source: Today’s Hospitalist Online Survey