PHOENIX – For every unit increase in baseline CHADS₂ score, the risk of postop atrial fibrillation increases by 17%, according to a retrospective chart review of 1,550 adults who had major vascular or thoracic surgery at the Mayo Clinic in Rochester, Minn.

On multivariate analysis, postop day 1 Sequential Organ Failure Assessment score (HR 1.08, 95% CI 1.03-1.12, per unit increase) and cumulative fluid balance (HR 1.03, 95% CI 1.01-1.06, per 1,000 mL) also correlated with the risk for new-onset atrial fibrillation (AF).

Baseline calcium channel blockers protected against new-onset AF (HR 0.52, 95% CI 0.37-0.73), but, paradoxically, the risk increased with baseline (HR 1.78, 95% CI 1.24-2.56) and postop (HR 1.44, 95% CI 1.05-1.99) beta-blocker use.

The relationship of CHADS₂ to new-onset AF (HR 1.17, 95% CI 1.04-1.31) could prove handy in the surgical ICU because “everyone is familiar with it, and it’s easy to calculate.” CHADS₂ (heart failure, hypertension, age, diabetes, prior stroke) has also recently been shown to predict AF after cardiac surgery, said lead investigator Kirstin Kooda, Pharm.D., a critical care pharmacist at Mayo.

The beta-blocker finding was a surprise, since beta-blockers are a standard AF treatment, Dr. Kooda said at the Critical Care Congress, sponsored by the Society for Critical Care Medicine. About 80% (175) of new-onset AF patients were on baseline beta-blockers, versus about 68% (892) who did not develop AF. Patients using beta-blockers received them the morning of surgery, and resumed them a median of 7 hours afterward. There were no significant differences in heart rates during surgery.

The team excluded patients with any history of AF and censored patients if they developed it, so the drugs’ use probably wasn’t related to a concern about the condition. Just under 70% of patients in both groups had baseline hypertension, another indication for the drugs.

Even so, the finding is probably real given the number of patients in the study. Most likely, the drugs were markers for additional risk factors not captured in the study, Dr. Kooda said.

Overall, 112 (20.7%) of the 540 thoracic patients and 107 (11%) of the 1,010 vascular patients developed new-onset AF a median of 55 hours after surgery. The incidence difference and timing are in line with previous reports.

The mean age in the AF group was 70 years, and in the non-AF group it was 66 years. In both, 65% were men, 5% had heart failure, 30% had diabetes, and 10% had prior strokes. Patients with pacemakers and recent myocardial infarctions – also possible settings for beta-blockers – were excluded from the trial.

The majority of the vascular cases were open aortic aneurysms, aortic bypasses, and thrombectomies or endarterectomies of central arteries. Most of the thoracic surgeries were lobectomies, pneumonectomies, and wedge or chest wall resections.

aotto@frontlinemedcom.com

PHOENIX – For every unit increase in baseline CHADS₂ score, the risk of postop atrial fibrillation increases by 17%, according to a retrospective chart review of 1,550 adults who had major vascular or thoracic surgery at the Mayo Clinic in Rochester, Minn.

On multivariate analysis, postop day 1 Sequential Organ Failure Assessment score (HR 1.08, 95% CI 1.03-1.12, per unit increase) and cumulative fluid balance (HR 1.03, 95% CI 1.01-1.06, per 1,000 mL) also correlated with the risk for new-onset atrial fibrillation (AF).

Baseline calcium channel blockers protected against new-onset AF (HR 0.52, 95% CI 0.37-0.73), but, paradoxically, the risk increased with baseline (HR 1.78, 95% CI 1.24-2.56) and postop (HR 1.44, 95% CI 1.05-1.99) beta-blocker use.

The relationship of CHADS₂ to new-onset AF (HR 1.17, 95% CI 1.04-1.31) could prove handy in the surgical ICU because “everyone is familiar with it, and it’s easy to calculate.” CHADS₂ (heart failure, hypertension, age, diabetes, prior stroke) has also recently been shown to predict AF after cardiac surgery, said lead investigator Kirstin Kooda, Pharm.D., a critical care pharmacist at Mayo.

The beta-blocker finding was a surprise, since beta-blockers are a standard AF treatment, Dr. Kooda said at the Critical Care Congress, sponsored by the Society for Critical Care Medicine. About 80% (175) of new-onset AF patients were on baseline beta-blockers, versus about 68% (892) who did not develop AF. Patients using beta-blockers received them the morning of surgery, and resumed them a median of 7 hours afterward. There were no significant differences in heart rates during surgery.

The team excluded patients with any history of AF and censored patients if they developed it, so the drugs’ use probably wasn’t related to a concern about the condition. Just under 70% of patients in both groups had baseline hypertension, another indication for the drugs.

Even so, the finding is probably real given the number of patients in the study. Most likely, the drugs were markers for additional risk factors not captured in the study, Dr. Kooda said.

Overall, 112 (20.7%) of the 540 thoracic patients and 107 (11%) of the 1,010 vascular patients developed new-onset AF a median of 55 hours after surgery. The incidence difference and timing are in line with previous reports.

The mean age in the AF group was 70 years, and in the non-AF group it was 66 years. In both, 65% were men, 5% had heart failure, 30% had diabetes, and 10% had prior strokes. Patients with pacemakers and recent myocardial infarctions – also possible settings for beta-blockers – were excluded from the trial.

The majority of the vascular cases were open aortic aneurysms, aortic bypasses, and thrombectomies or endarterectomies of central arteries. Most of the thoracic surgeries were lobectomies, pneumonectomies, and wedge or chest wall resections.

aotto@frontlinemedcom.com

PHOENIX – For every unit increase in baseline CHADS₂ score, the risk of postop atrial fibrillation increases by 17%, according to a retrospective chart review of 1,550 adults who had major vascular or thoracic surgery at the Mayo Clinic in Rochester, Minn.

On multivariate analysis, postop day 1 Sequential Organ Failure Assessment score (HR 1.08, 95% CI 1.03-1.12, per unit increase) and cumulative fluid balance (HR 1.03, 95% CI 1.01-1.06, per 1,000 mL) also correlated with the risk for new-onset atrial fibrillation (AF).

Baseline calcium channel blockers protected against new-onset AF (HR 0.52, 95% CI 0.37-0.73), but, paradoxically, the risk increased with baseline (HR 1.78, 95% CI 1.24-2.56) and postop (HR 1.44, 95% CI 1.05-1.99) beta-blocker use.

The relationship of CHADS₂ to new-onset AF (HR 1.17, 95% CI 1.04-1.31) could prove handy in the surgical ICU because “everyone is familiar with it, and it’s easy to calculate.” CHADS₂ (heart failure, hypertension, age, diabetes, prior stroke) has also recently been shown to predict AF after cardiac surgery, said lead investigator Kirstin Kooda, Pharm.D., a critical care pharmacist at Mayo.

The beta-blocker finding was a surprise, since beta-blockers are a standard AF treatment, Dr. Kooda said at the Critical Care Congress, sponsored by the Society for Critical Care Medicine. About 80% (175) of new-onset AF patients were on baseline beta-blockers, versus about 68% (892) who did not develop AF. Patients using beta-blockers received them the morning of surgery, and resumed them a median of 7 hours afterward. There were no significant differences in heart rates during surgery.

The team excluded patients with any history of AF and censored patients if they developed it, so the drugs’ use probably wasn’t related to a concern about the condition. Just under 70% of patients in both groups had baseline hypertension, another indication for the drugs.

Even so, the finding is probably real given the number of patients in the study. Most likely, the drugs were markers for additional risk factors not captured in the study, Dr. Kooda said.

Overall, 112 (20.7%) of the 540 thoracic patients and 107 (11%) of the 1,010 vascular patients developed new-onset AF a median of 55 hours after surgery. The incidence difference and timing are in line with previous reports.

The mean age in the AF group was 70 years, and in the non-AF group it was 66 years. In both, 65% were men, 5% had heart failure, 30% had diabetes, and 10% had prior strokes. Patients with pacemakers and recent myocardial infarctions – also possible settings for beta-blockers – were excluded from the trial.

The majority of the vascular cases were open aortic aneurysms, aortic bypasses, and thrombectomies or endarterectomies of central arteries. Most of the thoracic surgeries were lobectomies, pneumonectomies, and wedge or chest wall resections.

aotto@frontlinemedcom.com

Through genetic analysis, researchers used gene expression profiles to differentiate between several clinical phenotypes of VTE and distinguish high-risk patients from both low-risk patients and healthy controls, in a study published in Thrombosis Research.

Dr. Deborah A. Lewis of Duke University Medical Center and her associates used differential expression analysis to find several genes previously identified as potentially having a role in the development of thrombotic disorders, including SELP, KLKB1, ANXA5, andCD46. They then compared the genetic profiles of 107 patients, separated into low-, moderate-, or high-risk groups based on their clinical presentations of VTE, as well as 25 controls.

The most accurate comparisons were between the high-risk and low-risk groups, the high-risk group and the healthy controls, and the low-risk group and healthy controls, where the AUC levels were 0.81, 0.84 and 0.80 respectively.

“The profiles obtained … provide insights into approaches that might be useful in the identification of individuals with a single thrombotic event who are at highest risk for a recurrent VTE after completing a standard course of therapy,” the investigators wrote.

For the full article, click here (Thromb. Res. 2015 [doi:10.1016/j.thromres.2015.02.003]).

Through genetic analysis, researchers used gene expression profiles to differentiate between several clinical phenotypes of VTE and distinguish high-risk patients from both low-risk patients and healthy controls, in a study published in Thrombosis Research.

Dr. Deborah A. Lewis of Duke University Medical Center and her associates used differential expression analysis to find several genes previously identified as potentially having a role in the development of thrombotic disorders, including SELP, KLKB1, ANXA5, andCD46. They then compared the genetic profiles of 107 patients, separated into low-, moderate-, or high-risk groups based on their clinical presentations of VTE, as well as 25 controls.

The most accurate comparisons were between the high-risk and low-risk groups, the high-risk group and the healthy controls, and the low-risk group and healthy controls, where the AUC levels were 0.81, 0.84 and 0.80 respectively.

“The profiles obtained … provide insights into approaches that might be useful in the identification of individuals with a single thrombotic event who are at highest risk for a recurrent VTE after completing a standard course of therapy,” the investigators wrote.

For the full article, click here (Thromb. Res. 2015 [doi:10.1016/j.thromres.2015.02.003]).

Through genetic analysis, researchers used gene expression profiles to differentiate between several clinical phenotypes of VTE and distinguish high-risk patients from both low-risk patients and healthy controls, in a study published in Thrombosis Research.

Dr. Deborah A. Lewis of Duke University Medical Center and her associates used differential expression analysis to find several genes previously identified as potentially having a role in the development of thrombotic disorders, including SELP, KLKB1, ANXA5, andCD46. They then compared the genetic profiles of 107 patients, separated into low-, moderate-, or high-risk groups based on their clinical presentations of VTE, as well as 25 controls.

The most accurate comparisons were between the high-risk and low-risk groups, the high-risk group and the healthy controls, and the low-risk group and healthy controls, where the AUC levels were 0.81, 0.84 and 0.80 respectively.

“The profiles obtained … provide insights into approaches that might be useful in the identification of individuals with a single thrombotic event who are at highest risk for a recurrent VTE after completing a standard course of therapy,” the investigators wrote.

For the full article, click here (Thromb. Res. 2015 [doi:10.1016/j.thromres.2015.02.003]).

Incidence rates for developing venous thromboembolism (VTE) among esophagogastric cancer patients undergoing neoadjuvant chemotherapy in combination with curative intended surgery were significantly higher among patients with initial stage III and IV cancers and gastric cancer, according to a new study published in Thrombosis Research.

In the clinical prospective study, 129 patients with lower esophageal, gastroesophageal, and gastric cancer were examined between 2008 and 2011. Baseline assessments were recorded via bilateral compression ultrasound (biCUS) for deep vein thrombosis and computer tomography pulmonary angiography for pulmonary embolism. The patients received a chemotherapy regimen of oxaliplatin, capecitabine, and epirubicin, with curative intended surgery, and were examined before undergoing preoperative chemotherapy, surgery, and postoperative chemotherapy. The researchers encountered 21 VTE cases, or 16% of the total number of patients examined, with VTE incidences twice as likely to be asymptomatic than symptomatic.

The authors noted that state-of-the-art technology helped boost VTE detection rates among asymptomatic patients, and older studies may have underreported incidences of the disease.

“Although our study only included 129 patients, the systematic use of biCUS strongly suggests that the frequency of VTE is much greater than that previously reported for these types of cancer,” wrote Dr. Anders Christian Larsen and his associates at Aalborg University Hospital, Denmark.

Read more here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.021]).

Incidence rates for developing venous thromboembolism (VTE) among esophagogastric cancer patients undergoing neoadjuvant chemotherapy in combination with curative intended surgery were significantly higher among patients with initial stage III and IV cancers and gastric cancer, according to a new study published in Thrombosis Research.

In the clinical prospective study, 129 patients with lower esophageal, gastroesophageal, and gastric cancer were examined between 2008 and 2011. Baseline assessments were recorded via bilateral compression ultrasound (biCUS) for deep vein thrombosis and computer tomography pulmonary angiography for pulmonary embolism. The patients received a chemotherapy regimen of oxaliplatin, capecitabine, and epirubicin, with curative intended surgery, and were examined before undergoing preoperative chemotherapy, surgery, and postoperative chemotherapy. The researchers encountered 21 VTE cases, or 16% of the total number of patients examined, with VTE incidences twice as likely to be asymptomatic than symptomatic.

The authors noted that state-of-the-art technology helped boost VTE detection rates among asymptomatic patients, and older studies may have underreported incidences of the disease.

“Although our study only included 129 patients, the systematic use of biCUS strongly suggests that the frequency of VTE is much greater than that previously reported for these types of cancer,” wrote Dr. Anders Christian Larsen and his associates at Aalborg University Hospital, Denmark.

Read more here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.021]).

Incidence rates for developing venous thromboembolism (VTE) among esophagogastric cancer patients undergoing neoadjuvant chemotherapy in combination with curative intended surgery were significantly higher among patients with initial stage III and IV cancers and gastric cancer, according to a new study published in Thrombosis Research.

In the clinical prospective study, 129 patients with lower esophageal, gastroesophageal, and gastric cancer were examined between 2008 and 2011. Baseline assessments were recorded via bilateral compression ultrasound (biCUS) for deep vein thrombosis and computer tomography pulmonary angiography for pulmonary embolism. The patients received a chemotherapy regimen of oxaliplatin, capecitabine, and epirubicin, with curative intended surgery, and were examined before undergoing preoperative chemotherapy, surgery, and postoperative chemotherapy. The researchers encountered 21 VTE cases, or 16% of the total number of patients examined, with VTE incidences twice as likely to be asymptomatic than symptomatic.

The authors noted that state-of-the-art technology helped boost VTE detection rates among asymptomatic patients, and older studies may have underreported incidences of the disease.

“Although our study only included 129 patients, the systematic use of biCUS strongly suggests that the frequency of VTE is much greater than that previously reported for these types of cancer,” wrote Dr. Anders Christian Larsen and his associates at Aalborg University Hospital, Denmark.

Read more here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.021]).

The anticoagulant response to dabigatran, as measured by five coagulation laboratory assays, is consistent over childhood and comparable to the adult response, according to a research article published in Thrombosis Research.

In the in vitro study, lead author Dr. Kevin Dietrich of the University of Alberta, Canada, and his associates measured pooled plasma samples spiked with increasing concentrations of dabigatran from healthy children aged 0 to <1, 1 to <5, 5 to <10, 10 to <17 years, and adults. There were no differences in responses to dabigatran over all pediatric age groups, and these were comparable to adults.

The researchers found the dilute thrombin time (dTT) to be the most accurate measurement for assessing dabigatran concentrations in children and adults, as the ecarin time and TT were found to be overly sensitive.

“From a practical perspective, the dTT is an appropriate tool for measuring dabigatran concentrations. The dTT performed consistently across all age groups, and showed good reproducibility between repeat measurements and appropriate sensitivity and linearity of response within and above the therapeutic range,” they wrote.

For the full article, click here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.017]).

The anticoagulant response to dabigatran, as measured by five coagulation laboratory assays, is consistent over childhood and comparable to the adult response, according to a research article published in Thrombosis Research.

In the in vitro study, lead author Dr. Kevin Dietrich of the University of Alberta, Canada, and his associates measured pooled plasma samples spiked with increasing concentrations of dabigatran from healthy children aged 0 to <1, 1 to <5, 5 to <10, 10 to <17 years, and adults. There were no differences in responses to dabigatran over all pediatric age groups, and these were comparable to adults.

The researchers found the dilute thrombin time (dTT) to be the most accurate measurement for assessing dabigatran concentrations in children and adults, as the ecarin time and TT were found to be overly sensitive.

“From a practical perspective, the dTT is an appropriate tool for measuring dabigatran concentrations. The dTT performed consistently across all age groups, and showed good reproducibility between repeat measurements and appropriate sensitivity and linearity of response within and above the therapeutic range,” they wrote.

For the full article, click here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.017]).

The anticoagulant response to dabigatran, as measured by five coagulation laboratory assays, is consistent over childhood and comparable to the adult response, according to a research article published in Thrombosis Research.

In the in vitro study, lead author Dr. Kevin Dietrich of the University of Alberta, Canada, and his associates measured pooled plasma samples spiked with increasing concentrations of dabigatran from healthy children aged 0 to <1, 1 to <5, 5 to <10, 10 to <17 years, and adults. There were no differences in responses to dabigatran over all pediatric age groups, and these were comparable to adults.

The researchers found the dilute thrombin time (dTT) to be the most accurate measurement for assessing dabigatran concentrations in children and adults, as the ecarin time and TT were found to be overly sensitive.

“From a practical perspective, the dTT is an appropriate tool for measuring dabigatran concentrations. The dTT performed consistently across all age groups, and showed good reproducibility between repeat measurements and appropriate sensitivity and linearity of response within and above the therapeutic range,” they wrote.

For the full article, click here (Thrombosis Research 2015 [doi:10.1016/j.thromres.2015.01.017]).

Ablative fractional laser–assisted delivery of topical fluorouracil resulted in 100% histologic clearance in patients with squamous cell carcinoma in situ and 71% in patients with superficial basal cell carcinoma, based on data from 28 patients (mean age 71 years). Each patient underwent one pass with an ablative fractional laser, followed by one application of topical 5-FU 5% under occlusion for 7 days.

Histologic clearance and patient satisfaction were assessed 4-8 weeks after treatment; no serious adverse events were reported, and all patients said they would recommend the treatment to others.

“This treatment modality may be particularly useful for older patients, tumors located on lower extremities or back, and multiple tumors scattered on different areas of the body,” although controlled studies in diverse populations with longer follow-up times are needed, wrote Dr. Bichchau T. Nguyen of Tufts University, Boston, and colleagues (JAAD 2015; 72:558-60).

Read the full article from the Journal of the American Academy of Dermatology here.

Ablative fractional laser–assisted delivery of topical fluorouracil resulted in 100% histologic clearance in patients with squamous cell carcinoma in situ and 71% in patients with superficial basal cell carcinoma, based on data from 28 patients (mean age 71 years). Each patient underwent one pass with an ablative fractional laser, followed by one application of topical 5-FU 5% under occlusion for 7 days.

Histologic clearance and patient satisfaction were assessed 4-8 weeks after treatment; no serious adverse events were reported, and all patients said they would recommend the treatment to others.

“This treatment modality may be particularly useful for older patients, tumors located on lower extremities or back, and multiple tumors scattered on different areas of the body,” although controlled studies in diverse populations with longer follow-up times are needed, wrote Dr. Bichchau T. Nguyen of Tufts University, Boston, and colleagues (JAAD 2015; 72:558-60).

Read the full article from the Journal of the American Academy of Dermatology here.

Ablative fractional laser–assisted delivery of topical fluorouracil resulted in 100% histologic clearance in patients with squamous cell carcinoma in situ and 71% in patients with superficial basal cell carcinoma, based on data from 28 patients (mean age 71 years). Each patient underwent one pass with an ablative fractional laser, followed by one application of topical 5-FU 5% under occlusion for 7 days.

Histologic clearance and patient satisfaction were assessed 4-8 weeks after treatment; no serious adverse events were reported, and all patients said they would recommend the treatment to others.

“This treatment modality may be particularly useful for older patients, tumors located on lower extremities or back, and multiple tumors scattered on different areas of the body,” although controlled studies in diverse populations with longer follow-up times are needed, wrote Dr. Bichchau T. Nguyen of Tufts University, Boston, and colleagues (JAAD 2015; 72:558-60).

Read the full article from the Journal of the American Academy of Dermatology here.

An investigation of hospitalization costs for venous thromboembolism patients revealed that deep vein thrombosis (DVT) patients incurred an average cost of $1,594 per hospitalization day, while pulmonary embolism (PE) patients accounted for $1,735 per day. The costs stabilized on the third day for both groups, according to an investigation published in Thrombosis Research.

Joseph F. Dasta of the University of Texas College of Pharmacy, Round Rock, and his associates examined 28,953 DVT and 35,550 PE patients, identified from January 2009 to March 2013, in a longitudinal, cohort-based study. The mean lengths of stay for the DVT and PE cohorts were 4.7 days and 5.4 days, respectively. The room and board costs were the biggest, accounting for 40%-53% of the total costs of the DVT cohort and 38%-59% of the costs of the PE cohort, depending on the day. Pharmacy costs for both groups remained stable throughout the hospital stay.

The researchers noted that there may be a higher degree of severity in DVT patients vs. those with PE, as DVT patients had qualitatively higher surgery, supply, and pharmacy costs relative to PE patients. “The results of this study suggest that any change in treatment strategies or protocols that could effect [length of stay] may impact the hospitalization costs of DVT and PE populations,” they concluded.

Read more here: (Thromb. Res. 2015;135:303-10).

An investigation of hospitalization costs for venous thromboembolism patients revealed that deep vein thrombosis (DVT) patients incurred an average cost of $1,594 per hospitalization day, while pulmonary embolism (PE) patients accounted for $1,735 per day. The costs stabilized on the third day for both groups, according to an investigation published in Thrombosis Research.

Joseph F. Dasta of the University of Texas College of Pharmacy, Round Rock, and his associates examined 28,953 DVT and 35,550 PE patients, identified from January 2009 to March 2013, in a longitudinal, cohort-based study. The mean lengths of stay for the DVT and PE cohorts were 4.7 days and 5.4 days, respectively. The room and board costs were the biggest, accounting for 40%-53% of the total costs of the DVT cohort and 38%-59% of the costs of the PE cohort, depending on the day. Pharmacy costs for both groups remained stable throughout the hospital stay.

The researchers noted that there may be a higher degree of severity in DVT patients vs. those with PE, as DVT patients had qualitatively higher surgery, supply, and pharmacy costs relative to PE patients. “The results of this study suggest that any change in treatment strategies or protocols that could effect [length of stay] may impact the hospitalization costs of DVT and PE populations,” they concluded.

Read more here: (Thromb. Res. 2015;135:303-10).

An investigation of hospitalization costs for venous thromboembolism patients revealed that deep vein thrombosis (DVT) patients incurred an average cost of $1,594 per hospitalization day, while pulmonary embolism (PE) patients accounted for $1,735 per day. The costs stabilized on the third day for both groups, according to an investigation published in Thrombosis Research.

Joseph F. Dasta of the University of Texas College of Pharmacy, Round Rock, and his associates examined 28,953 DVT and 35,550 PE patients, identified from January 2009 to March 2013, in a longitudinal, cohort-based study. The mean lengths of stay for the DVT and PE cohorts were 4.7 days and 5.4 days, respectively. The room and board costs were the biggest, accounting for 40%-53% of the total costs of the DVT cohort and 38%-59% of the costs of the PE cohort, depending on the day. Pharmacy costs for both groups remained stable throughout the hospital stay.

The researchers noted that there may be a higher degree of severity in DVT patients vs. those with PE, as DVT patients had qualitatively higher surgery, supply, and pharmacy costs relative to PE patients. “The results of this study suggest that any change in treatment strategies or protocols that could effect [length of stay] may impact the hospitalization costs of DVT and PE populations,” they concluded.

Read more here: (Thromb. Res. 2015;135:303-10).

Adding an ablative fractional laser to daylight-assisted photodynamic therapy significantly improved the clearance rate of actinic keratoses in organ transplant recipients, compared with daylight PDT alone, conventional PDT alone, or ablative fractional laser alone, based on data from the treatment of 542 AKs in 16 adult patients reported by Dr. Katrine Togsverd-Bo of the University of Copenhagen, Denmark, and her colleagues (Br. J. Dermatol. 2015;172:467-74).

Each patient underwent each of the four treatment modalities on four randomized areas on the same region of the body. Three months after treatment, AK clearance rates were 74% for the combination AFL-dPDT, compared with 46% for daylight PDT alone, 50% for conventional PDT alone, and 5% for ablative fractional laser alone (P < .001).

Read the full article from the British Journal of Dermatology here.

Adding an ablative fractional laser to daylight-assisted photodynamic therapy significantly improved the clearance rate of actinic keratoses in organ transplant recipients, compared with daylight PDT alone, conventional PDT alone, or ablative fractional laser alone, based on data from the treatment of 542 AKs in 16 adult patients reported by Dr. Katrine Togsverd-Bo of the University of Copenhagen, Denmark, and her colleagues (Br. J. Dermatol. 2015;172:467-74).

Each patient underwent each of the four treatment modalities on four randomized areas on the same region of the body. Three months after treatment, AK clearance rates were 74% for the combination AFL-dPDT, compared with 46% for daylight PDT alone, 50% for conventional PDT alone, and 5% for ablative fractional laser alone (P < .001).

Read the full article from the British Journal of Dermatology here.

Adding an ablative fractional laser to daylight-assisted photodynamic therapy significantly improved the clearance rate of actinic keratoses in organ transplant recipients, compared with daylight PDT alone, conventional PDT alone, or ablative fractional laser alone, based on data from the treatment of 542 AKs in 16 adult patients reported by Dr. Katrine Togsverd-Bo of the University of Copenhagen, Denmark, and her colleagues (Br. J. Dermatol. 2015;172:467-74).

Each patient underwent each of the four treatment modalities on four randomized areas on the same region of the body. Three months after treatment, AK clearance rates were 74% for the combination AFL-dPDT, compared with 46% for daylight PDT alone, 50% for conventional PDT alone, and 5% for ablative fractional laser alone (P < .001).

Read the full article from the British Journal of Dermatology here.

There were no significant differences between the anticoagulants rivaroxaban (Xarelto) and enoxaparin (Lovenox) in terms of venous thromboembolism prophylaxis, infection, reoperation, transfusion, or major bleeding complications after primary hip and knee arthroplasty, according to a study published in the Journal of Arthroplasty.

In a non–industry-funded retrospective cohort study, Dr. Michael A. Charters of Henry Ford Health System in Detroit and his associates looked at 2,406 patients who underwent total hip and knee arthroplasty between 2009 and 2011. Of the 1,762 patients ultimately included in the study, 1,113 (63.2%) received enoxaparin and 649 (36.8%) received rivaroxaban for VTE prophylaxis. The deep venous thrombosis rate of the enoxaparin group was 1.8%, compared with 0.9% in the rivaroxaban group (P = .208) and the pulmonary embolism rate of the enoxaparin group was 0.7%, compared with 0.3% in the rivaroxaban group (P = .437).

“For standard primary THA [total hip arthroplasty] and TKA [total knee arthroplasty], these medications appear to be equally effective without increased adverse events,” the researchers said.

Read the full article at: The Journal of Arthoplasty 2015 (www.arthroplastyjournal.org/article/S0883-5403%2815%2900120-5/abstract).

There were no significant differences between the anticoagulants rivaroxaban (Xarelto) and enoxaparin (Lovenox) in terms of venous thromboembolism prophylaxis, infection, reoperation, transfusion, or major bleeding complications after primary hip and knee arthroplasty, according to a study published in the Journal of Arthroplasty.

In a non–industry-funded retrospective cohort study, Dr. Michael A. Charters of Henry Ford Health System in Detroit and his associates looked at 2,406 patients who underwent total hip and knee arthroplasty between 2009 and 2011. Of the 1,762 patients ultimately included in the study, 1,113 (63.2%) received enoxaparin and 649 (36.8%) received rivaroxaban for VTE prophylaxis. The deep venous thrombosis rate of the enoxaparin group was 1.8%, compared with 0.9% in the rivaroxaban group (P = .208) and the pulmonary embolism rate of the enoxaparin group was 0.7%, compared with 0.3% in the rivaroxaban group (P = .437).

“For standard primary THA [total hip arthroplasty] and TKA [total knee arthroplasty], these medications appear to be equally effective without increased adverse events,” the researchers said.

Read the full article at: The Journal of Arthoplasty 2015 (www.arthroplastyjournal.org/article/S0883-5403%2815%2900120-5/abstract).

There were no significant differences between the anticoagulants rivaroxaban (Xarelto) and enoxaparin (Lovenox) in terms of venous thromboembolism prophylaxis, infection, reoperation, transfusion, or major bleeding complications after primary hip and knee arthroplasty, according to a study published in the Journal of Arthroplasty.

In a non–industry-funded retrospective cohort study, Dr. Michael A. Charters of Henry Ford Health System in Detroit and his associates looked at 2,406 patients who underwent total hip and knee arthroplasty between 2009 and 2011. Of the 1,762 patients ultimately included in the study, 1,113 (63.2%) received enoxaparin and 649 (36.8%) received rivaroxaban for VTE prophylaxis. The deep venous thrombosis rate of the enoxaparin group was 1.8%, compared with 0.9% in the rivaroxaban group (P = .208) and the pulmonary embolism rate of the enoxaparin group was 0.7%, compared with 0.3% in the rivaroxaban group (P = .437).

“For standard primary THA [total hip arthroplasty] and TKA [total knee arthroplasty], these medications appear to be equally effective without increased adverse events,” the researchers said.

Read the full article at: The Journal of Arthoplasty 2015 (www.arthroplastyjournal.org/article/S0883-5403%2815%2900120-5/abstract).

PHOENIX – Trauma patients probably need an elevated dose of enoxaparin – perhaps 40 mg twice daily – to prevent venous thromboembolisms, according to a prospective study of 85 trauma patients at the Palmetto Health Richland hospital in Columbia, S.C.

Also, antifactor 10a – a blood test often used in research to gauge how well enoxaparin (Lovenox) is thinning the blood – doesn’t work very well as an empiric measure of anticoagulation; thromboelastography (TEG) may be better, lead investigator Janise Phillips, Pharm.D., said at the Critical Care Congress, sponsored by the Society of Critical Care Medicine.

Her team tracked trauma patients who had at least three consecutive doses of enoxaparin prophylaxis for venous thromboembolism (VTE) and at least one peak antifactor 10a level drawn; enoxaparin doses were adjusted as needed to hit a weekly antifactor 10a level of 0.20-0.40 IU/mL, which is thought to be the therapeutic range for enoxaparin. Patients were in the ICU for a median of about 10 days, and in the hospital for about 2-3 weeks.

The types of trauma were not reported in the study, but the investigation confirms prior findings that critically ill trauma patients – and perhaps burn patients – need higher anticoagulant doses.

Overall, 65% (13) of patients on an initial enoxaparin regimen of 30 mg subcutaneously twice daily were below anti-factor 10a levels of 0.20-0.40 IU/mL after their first dose; 22% (8) were subtherapeutic after an initial dose of 40 mg once daily; and 21% (6) were subtherapeutic after an initial dose of 40 mg twice daily.

Antifactor 10a levels didn’t match well with clinical benefit. VTEs were diagnosed in 15% (4) of patients with an initial subtherapeutic antifactor 10a level, but 15% (4) bled on their subtherapeutic dose; 8.5% (4) of patients with an initial therapeutic level had a VTE, vs. none who were supratherapeutic after their initial dose. However, 9% (1) of supratherapeutic patients had an enoxaparin bleed.

“These were trauma patients in and out of surgery. A lot of the time, we had to stop the dose and hold it, which may” explain why subtherapeutic patients had the highest VTE risk, said Dr. Phillips, now a critical care pharmacist at the Cleveland Clinic hospital in Abu Dhabi, United Arab Emirates.

More than half of the patients were men, and being male was the only factor that seemed to increase the risk of subtherapeutic enoxaparin levels (P = .04). There was a trend for subtherapeutic levels in heavier patients – which might help explain the higher risk in men – and those with diminished kidney function. Even so, the fact that both VTEs and bleeding were most likely in underdosed patients could mean that antifactor 10a “is really not the best marker for VTE risk. At $80 a pop, it isn’t cost-effective, and [even] patients with therapeutic levels ended up with clots. TEG gives you a real time view of the coagulation status of the patient,” and may be the way to go, Dr. Phillips said.

aotto@frontlinemedcom.com

PHOENIX – Trauma patients probably need an elevated dose of enoxaparin – perhaps 40 mg twice daily – to prevent venous thromboembolisms, according to a prospective study of 85 trauma patients at the Palmetto Health Richland hospital in Columbia, S.C.

Also, antifactor 10a – a blood test often used in research to gauge how well enoxaparin (Lovenox) is thinning the blood – doesn’t work very well as an empiric measure of anticoagulation; thromboelastography (TEG) may be better, lead investigator Janise Phillips, Pharm.D., said at the Critical Care Congress, sponsored by the Society of Critical Care Medicine.

Her team tracked trauma patients who had at least three consecutive doses of enoxaparin prophylaxis for venous thromboembolism (VTE) and at least one peak antifactor 10a level drawn; enoxaparin doses were adjusted as needed to hit a weekly antifactor 10a level of 0.20-0.40 IU/mL, which is thought to be the therapeutic range for enoxaparin. Patients were in the ICU for a median of about 10 days, and in the hospital for about 2-3 weeks.

The types of trauma were not reported in the study, but the investigation confirms prior findings that critically ill trauma patients – and perhaps burn patients – need higher anticoagulant doses.

Overall, 65% (13) of patients on an initial enoxaparin regimen of 30 mg subcutaneously twice daily were below anti-factor 10a levels of 0.20-0.40 IU/mL after their first dose; 22% (8) were subtherapeutic after an initial dose of 40 mg once daily; and 21% (6) were subtherapeutic after an initial dose of 40 mg twice daily.

Antifactor 10a levels didn’t match well with clinical benefit. VTEs were diagnosed in 15% (4) of patients with an initial subtherapeutic antifactor 10a level, but 15% (4) bled on their subtherapeutic dose; 8.5% (4) of patients with an initial therapeutic level had a VTE, vs. none who were supratherapeutic after their initial dose. However, 9% (1) of supratherapeutic patients had an enoxaparin bleed.

“These were trauma patients in and out of surgery. A lot of the time, we had to stop the dose and hold it, which may” explain why subtherapeutic patients had the highest VTE risk, said Dr. Phillips, now a critical care pharmacist at the Cleveland Clinic hospital in Abu Dhabi, United Arab Emirates.

More than half of the patients were men, and being male was the only factor that seemed to increase the risk of subtherapeutic enoxaparin levels (P = .04). There was a trend for subtherapeutic levels in heavier patients – which might help explain the higher risk in men – and those with diminished kidney function. Even so, the fact that both VTEs and bleeding were most likely in underdosed patients could mean that antifactor 10a “is really not the best marker for VTE risk. At $80 a pop, it isn’t cost-effective, and [even] patients with therapeutic levels ended up with clots. TEG gives you a real time view of the coagulation status of the patient,” and may be the way to go, Dr. Phillips said.

aotto@frontlinemedcom.com

PHOENIX – Trauma patients probably need an elevated dose of enoxaparin – perhaps 40 mg twice daily – to prevent venous thromboembolisms, according to a prospective study of 85 trauma patients at the Palmetto Health Richland hospital in Columbia, S.C.

Also, antifactor 10a – a blood test often used in research to gauge how well enoxaparin (Lovenox) is thinning the blood – doesn’t work very well as an empiric measure of anticoagulation; thromboelastography (TEG) may be better, lead investigator Janise Phillips, Pharm.D., said at the Critical Care Congress, sponsored by the Society of Critical Care Medicine.

Her team tracked trauma patients who had at least three consecutive doses of enoxaparin prophylaxis for venous thromboembolism (VTE) and at least one peak antifactor 10a level drawn; enoxaparin doses were adjusted as needed to hit a weekly antifactor 10a level of 0.20-0.40 IU/mL, which is thought to be the therapeutic range for enoxaparin. Patients were in the ICU for a median of about 10 days, and in the hospital for about 2-3 weeks.

The types of trauma were not reported in the study, but the investigation confirms prior findings that critically ill trauma patients – and perhaps burn patients – need higher anticoagulant doses.

Overall, 65% (13) of patients on an initial enoxaparin regimen of 30 mg subcutaneously twice daily were below anti-factor 10a levels of 0.20-0.40 IU/mL after their first dose; 22% (8) were subtherapeutic after an initial dose of 40 mg once daily; and 21% (6) were subtherapeutic after an initial dose of 40 mg twice daily.

Antifactor 10a levels didn’t match well with clinical benefit. VTEs were diagnosed in 15% (4) of patients with an initial subtherapeutic antifactor 10a level, but 15% (4) bled on their subtherapeutic dose; 8.5% (4) of patients with an initial therapeutic level had a VTE, vs. none who were supratherapeutic after their initial dose. However, 9% (1) of supratherapeutic patients had an enoxaparin bleed.

“These were trauma patients in and out of surgery. A lot of the time, we had to stop the dose and hold it, which may” explain why subtherapeutic patients had the highest VTE risk, said Dr. Phillips, now a critical care pharmacist at the Cleveland Clinic hospital in Abu Dhabi, United Arab Emirates.

More than half of the patients were men, and being male was the only factor that seemed to increase the risk of subtherapeutic enoxaparin levels (P = .04). There was a trend for subtherapeutic levels in heavier patients – which might help explain the higher risk in men – and those with diminished kidney function. Even so, the fact that both VTEs and bleeding were most likely in underdosed patients could mean that antifactor 10a “is really not the best marker for VTE risk. At $80 a pop, it isn’t cost-effective, and [even] patients with therapeutic levels ended up with clots. TEG gives you a real time view of the coagulation status of the patient,” and may be the way to go, Dr. Phillips said.

aotto@frontlinemedcom.com

The risk of inflammatory bowel disease (IBD) patients developing deep vein thrombosis and pulmonary embolism was 1.98-fold and 1.80-fold higher, respectively, than those without the disease, according to research published in Thrombosis Research.

To explore the connection between deep vein thrombosis (DVT) and IBD, Dr. Wei-Sheng Chung of Taichung (Taiwan) Hospital and associates compared 11,445 IBD patients and 45,780 controls in a nationwide, population-based cohort study.

The IBD patients had a higher prevalence of comorbidities than their peers, including atrial fibrillation, hypertension, diabetes, heart failure, and cerebral vascular disease. In addition, the IBD patients who were hospitalized twice per year exhibited a significantly greater risk of developing DVT (adjusted hazard ratio, 32.9; 95% confidence interval, 20.5-52.8) and pulmonary embolism (adjusted HR, 24.2; 95% CI, 11.1-52.9) than did the comparison cohort.

Read more here: (Thromb. Res. 2015;135:492-6 [http://dx.doi.org/10.1016/j.thromres.2014.12.025]).

The risk of inflammatory bowel disease (IBD) patients developing deep vein thrombosis and pulmonary embolism was 1.98-fold and 1.80-fold higher, respectively, than those without the disease, according to research published in Thrombosis Research.

To explore the connection between deep vein thrombosis (DVT) and IBD, Dr. Wei-Sheng Chung of Taichung (Taiwan) Hospital and associates compared 11,445 IBD patients and 45,780 controls in a nationwide, population-based cohort study.

The IBD patients had a higher prevalence of comorbidities than their peers, including atrial fibrillation, hypertension, diabetes, heart failure, and cerebral vascular disease. In addition, the IBD patients who were hospitalized twice per year exhibited a significantly greater risk of developing DVT (adjusted hazard ratio, 32.9; 95% confidence interval, 20.5-52.8) and pulmonary embolism (adjusted HR, 24.2; 95% CI, 11.1-52.9) than did the comparison cohort.

Read more here: (Thromb. Res. 2015;135:492-6 [http://dx.doi.org/10.1016/j.thromres.2014.12.025]).

The risk of inflammatory bowel disease (IBD) patients developing deep vein thrombosis and pulmonary embolism was 1.98-fold and 1.80-fold higher, respectively, than those without the disease, according to research published in Thrombosis Research.

To explore the connection between deep vein thrombosis (DVT) and IBD, Dr. Wei-Sheng Chung of Taichung (Taiwan) Hospital and associates compared 11,445 IBD patients and 45,780 controls in a nationwide, population-based cohort study.

The IBD patients had a higher prevalence of comorbidities than their peers, including atrial fibrillation, hypertension, diabetes, heart failure, and cerebral vascular disease. In addition, the IBD patients who were hospitalized twice per year exhibited a significantly greater risk of developing DVT (adjusted hazard ratio, 32.9; 95% confidence interval, 20.5-52.8) and pulmonary embolism (adjusted HR, 24.2; 95% CI, 11.1-52.9) than did the comparison cohort.

Read more here: (Thromb. Res. 2015;135:492-6 [http://dx.doi.org/10.1016/j.thromres.2014.12.025]).