A Novel Vancomycin Standardized Calculations Method Achieved Therapeutic Trough Goals in Obese and Non-obese Patients in a Veterans Affairs Health Care System

Abstract Background Pharmacokinetic dosing of vancomycin in obese patients has not been standardized. Limited literature is available on appropriate dosing of vancomycin in this increasing population. We evaluated the utilization and impact of a standardized calculation method (SCM) in obtaining therapeutic vancomycin levels. Methods A SCM, including the use of an adjusted body weight for dosing and volume of distribution in obese patients, was implemented at our institution April 2014. Retrospective medical records review of hospitalized patients with a vancomycin steady-state trough level pre- (February 2013 to March 2014) and post-implementation (June 2014 to July 2015) of the SCM. Patients with dialysis, paraplegia/quadriplegia, vancomycin level drawn < 48 hours of admit, trough level drawn > 2 hours prior to next dose, during or after vancomycin infusion were excluded. Appropriateness of vancomycin levels were evaluated between the pre- (PreG) and post-groups (PostG), as well as BMI classification. Nephrotoxicity was defined as a rise in serum creatinine > 0.5 mg/dl or > 50% from baseline during or up to 72 hours after stopping vancomycin therapy. Appropriate statistical tests were analyzed using SPSS-PC (ver. 24, Chicago, IL). Results There were no significant differences in the PreG (n = 97) and PostG (n = 97) for age, gender, length of vancomycin therapy, and non-obese and obese patients. In the PostG, significant improvement in the overall use of the SCM (P < 0.001) was determined. Other significant (P < 0.001) factors associated with vancomycin patient management in the PostG were found. There was an overall significant improvement in achieving a therapeutic trough goal of 10–20 (±1 mcg/ml) in BMI classes, predominantly in BMI Class 4 PreG 26% and PostG 74%, P < 0.05. More patients in the PreG (11) had the first trough >21 mcg/ml than the PostG, (4), P = 0.104. Patients who developed nephrotoxicity included PreG 15% and 0% PostG, P = 0.115. Conclusion SCM of vancomycin regimens resulted in a significant improvement in obtaining therapeutic trough levels overall, including the obese BMI class 4. Defined nephrotoxicity was absent in the PostG group. Disclosures All authors: No reported disclosures.

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Prophylactic Enoxaparin in Critically Ill Trauma Patients: Evaluation of the Initial Dose

Hospital Pharmacy ◽

10.1177/00185787211067374 ◽

2021 ◽

pp. 001857872110673

Author(s):

Kaitlyn J. Agedal ◽

Elizabeth A. Feldman ◽

Robert W. Seabury ◽

William Darko ◽

Luke A. Probst ◽

...

Keyword(s):

Critically Ill ◽

Patient Population ◽

Trough Level ◽

Statistical Tests ◽

Coagulation Cascade ◽

Surgical Intensive Care Unit ◽

Trauma Patients ◽

Surgical Intensive Care ◽

Increased Risk ◽

Trough Levels

Background: Trauma patients are at increased risk of developing venous thromboembolism given alterations in the coagulation cascade. Chemoprophylaxis with standard dosing of enoxaparin 30 mg subcutaneously twice daily has evolved to incorporate the use of anti-factor Xa (AFXa) trough level monitoring given concerns for decreased enoxaparin bioavailability in this patient population. Current available evidence suggests low rates of goal AFXa trough level achievement with standard enoxaparin dosing. Our study aims to identify the incidence of critically ill trauma patients that did not achieve goal AFXa trough levels and attempts to identify predictors that may influence the lack of achievement of goal levels. Methods: This was a retrospective, cohort analysis performed at a single academic medical center. Adult patients 18 years or older admitted to the surgical intensive care unit secondary to trauma who were initiated on standard prophylactic enoxaparin and had at least 1 AFXa trough level representative of steady state were included. Patient demographics and clinical data were collected, and descriptive statistics were utilized. All statistical tests were 2-tailed and a P < .05 was considered significant. Variables with a P < .10 on univariable analysis were included in a multivariable logistic regression analysis. Results: A majority of our patient population did not achieve goal AFXa trough levels while receiving standard doses of prophylactic enoxaparin (82.4% [108/131]). Sub-target AFXa levels were associated with higher creatinine clearance values. Positive predictors of obtaining target AFXa levels included automobile versus pedestrian mechanism of injury and requiring an enoxaparin dose escalation to at least 40 mg twice daily. Conclusions: Our study found low rates of achievement of goal AFXa trough levels in critically ill trauma patients receiving standard prophylactic enoxaparin dosing. Certain variables were identified as negative and positive predictors for achievement of goal AFXa trough levels, although the biologic plausibility of these predictors is questionable and requires further investigation.

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Unnecessary Antimicrobial Use in Patients with Current or Recent Clostridium difficile Infection

Infection Control and Hospital Epidemiology ◽

10.1086/669089 ◽

2013 ◽

Vol 34 (2) ◽

pp. 109-116 ◽

Cited By ~ 37

Author(s):

Megan K. Shaughnessy ◽

William H. Amundson ◽

Michael A. Kuskowski ◽

Douglas D. DeCarolis ◽

James R. Johnson ◽

...

Keyword(s):

Clostridium Difficile ◽

Medical Records ◽

Medical Center ◽

Multivariable Analysis ◽

Patient Characteristics ◽

Veterans Affairs ◽

Antimicrobial Use ◽

Factors Associated ◽

Drug Classes ◽

New Onset

Objective.To determine the fraction of unnecessary antimicrobial use among patients with current and/or recent Clostridium difficile infection (CDI).Design.Retrospective review from January 2004 through December 2006.Setting.Minneapolis Veterans Affairs Medical Center (MVAMC).Participants.Patients with new-onset CDI diagnosed at the MVAMC without another CDI diagnosis in the prior 30 days.Methods.Pharmacy and medical records were reviewed to identify incident CDI cases, non-CDI antimicrobial use during and up to 30 days after completion of CDI treatment, and patient characteristics. Two infectious disease physicians independently assessed non-CDI antimicrobial use, which was classified as unnecessary if not fully indicated. Factors associated with only unnecessary use were identified through univariable and multivariable analysis.Results.Of 246 patients with new-onset CDI, 141 (57%) received non-CDI antimicrobials during and/or after their CDI treatment, totaling 2,147 antimicrobial days and 445 antimicrobial courses. The two reviewers agreed regarding the necessity of antimicrobials in more than 99% of antimicrobial courses (85% initially, 14% after discussion). Seventy-seven percent of patients received at least 1 unnecessary antimicrobial dose, 26% of patients received only unnecessary antimicrobials, and 45% of total non-CDI antimicrobial days included unnecessary antimicrobials. The leading indications for unnecessary antimicrobial use were putative urinary tract infection and pneumonia. Drug classes frequently used unnecessarily were fluoroquinolones and β-lactams.Conclusions.Twenty-six percent of patients with recent CDI received only unnecessary (and therefore potentially avoidable) antimicrobials. Heightened awareness and caution are needed when antimicrobial therapy is contemplated for patients with recent CDI.

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AB0484 TROUGH LEVELS OF TNF-Α INHIBITORS AND THEIR IMMUNOGENICITY IN THE TREATMENT OF RHEUMATIC DISEASES AND INFLAMMATORY BOWEL DISEASES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4006 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1269.2-1270

Author(s):

T. Nuriakhmetova ◽

I. K. Valeeva ◽

J. Shevnina ◽

D. Abdulganieva

Keyword(s):

Rheumatic Diseases ◽

Inflammatory Bowel Diseases ◽

Trough Level ◽

Certolizumab Pegol ◽

Factors Associated ◽

Low Level ◽

Tnf Α ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Trough Levels

Background:The features of the underlying immune-mediated disease can affect the efficacy, pharmacokinetics and immunogenicity of the biologic agents, which are among the important predictors of loss of response to TNF-α inhibitors (TNFi).Objectives:To compare the frequency of TNFi low trough levels and their immunogenicity in the treatment of rheumatic diseases (RD) (ankylosing spondylitis (AS) and rheumatoid arthritis (RA)) and inflammatory bowel diseases (IBD) (Crohn’s disease (CD) and ulcerative colitis (UC)).Methods:Among 120 patients (40 with AS (33.3%), 19 with RA (15.8%), 42 with CD (35%), and 19 with UC (15.8%)), trough level of infliximab (INX) (n=36, 30%), adalimumab (ADM) (n=45, 37.5%) and certolizumab pegol (CZP) (n=39, 32.5%) and the level of anti-drug antibodies (ADAb) were measured in the serum samples drawn directly before the planned drug administration.Results:Low drug level (below 0.5 μg/mL for INX1, 4.9 µg/ml for ADM2, and 20 µg/l for CZP3) was found in 54 (45%) patients: in 33 (55.9%) patients with RD and 21 (34.4%) patients with IBD. In the RD group, low drug trough level was observed more often than in IBD (55.9% vs 34.4%, OR 2.418, 95% CI 1.157 to 5.052, p=0.018). Only in UC was there a relationship between the received low dose of the drug (up to 200 mg of INX, 40 mg of ADM, and 200 mg of CZP) and its low level in the serum (p=0.026). Among the additional factors associated with a low TNFi level, lower dose of concomitant therapy at the time of a biologic initiation (66.7% vs 20.8%, OR 7.6, 95% CI 1.388 to 41.617, p=0.033) and the absence of pseudopolyps (78.9% vs 21.1%, p=0.045) were found in IBD, and in case of RD these factors included the age of 30 to 45 years (72.7% vs 41.9%, OR 3.692, 95 % CI 1.136 to 12.0, p=0.026), the absence of comorbidities (58.6% vs 41.4%, OR 3.44, 1.09 to 10.858, p=0.032) and male gender (78.8% vs 50% in women, OR 3.714, 95% CI 1.194 to 11.552, p=0.02).ADAb were detected in 29 (24.2%) patients (7 to INX (19.4%), 8 (17.8%) to ADM, 14 (35.9%) to CZP), 23 (79.3%) of which had also a concomitant low trough level of the drug. There were no significant differences in the frequency of ADAb formation between the pathologies. In the AS group, antibodies to CZP were detected in all patients with a low level of the biologic, while only in 25% of patients receiving ADM, a low level was associated with the formation of ADAb (p=0.019). In addition, among patients with AS, ADAb were detected only in those patients who did not take prednisone at the time of blood serum sampling (100% vs 37.9%, p=0.037).Conclusion:Low level of TNFi is more common in RD than in IBD. For each group, the factors associated with a low trough level of TNFi were identified. There were no significant differences in the frequency of ADAb formation between nosologies.References:[1]Steenholdt C, Bendtzen K, Brynskov J, et al. Cut-off levels and diagnostic accuracy of infliximab trough levels and anti-infliximab antibodies in Crohn’s disease. Scand J Gastroenterol 2011; 46: 310–318.[2]Bartelds GM, Krieckaert CL, Nurmohamed MT, van Schouwenburg PA, Lems WF, Twisk JW, Dijkmans BA, Aarden L, Wolbink GJ. Development of antidrug antibodies against adalimumab and association with disease activity and treatment failure during long-term follow-up. JAMA. 2011;305:1460–1468. doi: 10.1001/jama.2011.406.[3]Gehin, J.E., Goll, G.L., Warren, D.J. et al. Associations between certolizumab pegol serum levels, anti-drug antibodies and treatment response in patients with inflammatory joint diseases: data from the NOR-DMARD study. Arthritis Res Ther 21, 256 (2019). https://doi.org/10.1186/s13075-019-2009-5Disclosure of Interests:Tatiana Nuriakhmetova Grant/research support from: A grant to purchase reagents for scientific research from Novartis Pharmaceuticals, Ildariya Khairullovna Valeeva: None declared., Jana Shevnina: None declared., Diana Abdulganieva: None declared.

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Characterizing the delays in adequate thromboprophylaxis after TBI

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000686 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000686

Author(s):

Navpreet K Dhillon ◽

Yassar M Hashim ◽

Naomi Berezin ◽

Felix Yong ◽

Geena Conde ◽

...

Keyword(s):

Unfractionated Heparin ◽

Medical Records ◽

Trough Level ◽

Target Range ◽

Trauma Patients ◽

Level Of Evidence ◽

Pharmacological Prophylaxis ◽

Vte Prophylaxis ◽

To Receive ◽

Trough Levels

BackgroundWe sought to compare enoxaparin dosing for venous thromboembolism (VTE) prophylaxis in trauma patients with and without traumatic brain injury (TBI) to better understand the time and dose required to reach target anti-Xa levels. Our hypothesis was that patients with TBI have significant delays in the initiation of adequate pharmacological prophylaxis and require a higher enoxaparin dose than currently recommended.MethodsThe medical records of trauma patients who received enoxaparin dosing based on anti-Xa trough levels between August 2014 and October 2016 were reviewed. Patients were included if their anti-Xa trough level reached the target range (0.1 IU/mL to 0.2 IU/mL).ResultsA total of 163 patients had anti-Xa levels within the target range of which 41 (25.2%) had TBI. Patients with TBI had longer delays before initiating enoxaparin (7.5 days vs. 1.5 days after admission, p<0.01) and were more likely to receive unfractionated heparin prior to enoxaparin (46.3% vs. 11.5%, p<0.01). Anti-Xa levels reached the target range later in patients with TBI (11 days vs. 5 days after admission, p<0.01). Enoxaparin 40 mg two times per day was the median dose required to reach the target anti-Xa levels for both cohorts. VTE rates were higher among patients with TBI (22.0% vs. 9.0%, p=0.03). Four patients (9.8%) had progression of their intracranial hemorrhage prior to receiving enoxaparin, although none progressed during enoxaparin administration.ConclusionAmong patients with TBI who reached target anti-Xa levels, 11 days after admission were required to reach a median enoxaparin dose of 40 mg two times per day. Unfractionated heparin was used as pharmacological prophylaxis in about half of these patients. The delay in reaching the target anti-Xa levels and the use of unfractionated heparin likely contribute to the higher VTE rate in patients with TBI.Level of evidenceLevel III, therapeutic.

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Rice tablet (Aluminum Phosphide) poisoning

International Journal of Bioassays ◽

10.21746/ijbio.2016.11.008 ◽

2016 ◽

Vol 5 (11) ◽

pp. 5041

Author(s):

Farkhondeh Jamshidi ◽

Ahmad Ghorbani ◽

Sina Darvishi*

Keyword(s):

Medical Records ◽

Statistical Tests ◽

Patient Records ◽

Demographic Information ◽

Aluminum Phosphide ◽

Men And Women ◽

Significant Difference ◽

The Mean ◽

Aluminum Phosphide Poisoning ◽

Commit Suicide

The abuse of some pesticides especially to suicide is one of the current problems of pesticides. Aluminum phosphide induced poisoning usually happens to suicide and sometimes it is due to accidental occupational exposure and in a few cases it has some criminal intensions. This study is conducted to evaluate patients poisoned with aluminum phosphide. In the present study the medical records of cases of poisoning with rice tablets (aluminum phosphide) hospitalized in Ahvaz Razi hospital is studied. Accordingly, a checklist is prepared that included demographic information of patients (age, gender) and information on patient records (information on poisoning) are completed using the patients’ medical records. The analysis of data is done by SPSS V22. 18 patients poisoned with rice tablet (aluminum phosphide) are studied. Results of the study show that 11 patients are male and seven are female. The mean patient age is 27.06 ±8.04 years that is 28 ±9 and 25 ±6.02 in men and women respectively. Statistical tests show no statistically significant difference in mean age in both genders (P> 0.05). Among patients, 11 subjects took aluminum phosphide to attempt suicide and 3 cases took it unintentionally and of course the reason is not mentioned in four cases. Among the patients who tried to commit suicide by taking aluminum phosphide, 6 cases are male and 5 cases are female that no statistically significant difference is observed between the genders in this respect (P> 0.05). In addition to the study of the complications caused by this poisoning and its mortality, it is recommended to responsible authorities to provide the necessary educations and treatments to prevent this type of poisoning.

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Factors associated with preterm birth at Wachemo University Nigist Eleni Mohammed memorial hospital, southern Ethiopia: case-control study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03503-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Negeso Gebeyehu Gejo ◽

Melaku Tesfaye W/mariam ◽

Biruk Assefa Kebede ◽

Ritbano Ahmed Abdo ◽

Abebe Alemu Anshebo ◽

...

Keyword(s):

Preterm Birth ◽

Antenatal Care ◽

Medical Records ◽

Case Control Study ◽

Southern Ethiopia ◽

Preterm Neonates ◽

Factors Associated ◽

Induced Hypertension ◽

Control Study

Abstract Background Preterm birth is defined as the birth of a baby before 37 completed weeks of gestation. Worldwide, prematurity is the second foremost cause of death in children under the age of 5 years. Preterm birth also gives rise to short and long term complications. Therefore, the primary aim of this study was to identify the factors associated with preterm birth in Wachemo University Nigist Eleni Mohammed Memorial referral hospital, Hadiya Zone, Southern Ethiopia. Methods An institution-based unmatched case-control study was conducted from July 01, 2018 to June 30, 2019 among mothers who gave birth in Wachemo University Nigest Eleni Mohammed Memorial referral hospital. A retrospective one-year data was retrieved from medical records of mothers with their index neonates. Simple random sampling technique was employed to recruit study participants. SPSS version 20 software was used for data entry and computing statistical analysis. Both bivariable and multivariable logistic regression analyses were used to determine the association of each independent variable with the dependent variable. Odds ratio with their 95% confidence intervals was computed to identify the presence and strength of association, and statistical significance was affirmed if p < 0.05. Result The current study evaluated 213 medical records of mothers with index neonates (71 cases and 142 controls). Urban residency [AOR = 0.48; 95% Cl; 0.239, 0.962], antenatal care follow up [AOR = 0.08; 95 Cl; 0.008, 0.694], premature rupture of membranes [AOR = 3.78; 95% Cl; 1.467, 9.749], pregnancy induced hypertension [AOR = 3.77; 95% Cl; 1.408, 10.147] and multiple pregnancies [AOR = 5.53; 95% Cl; 2.467, 12.412] were the factors associated with preterm birth. More than one-third (36.6%) preterm neonates died in the present study. Conclusions The present study found that urban residency, antenatal care follow up, premature rupture of membranes, pregnancy induced hypertension and multiple pregnancies were factors associated with preterm birth. The mortality among preterm neonates is high. Enhancing antenatal care follow up and early detection and treatment of disorders among pregnant women during antenatal care and undertaking every effort to improve outcomes of preterm birth and reduce neonatal mortality associated with prematurity is decisive.

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1306. Comparison of the Use of Extended and Intermittent Infusion Cefepime and Piperacillin/tazobactam in Non-critically Ill, Obese Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1489 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S667-S667

Author(s):

Carolyn Marg ◽

Zach DeLanoit ◽

Kimberly D Boeser

Keyword(s):

Clinical Success ◽

Small Sample Size ◽

Clinical Success Rate ◽

Intermittent Infusion ◽

Volume Of Distribution ◽

Small Sample ◽

Hospital Length Of Stay ◽

Obese Patients ◽

Target Time ◽

All Cause Mortality

Abstract Background Obesity rates have dramatically increased over the last several decades, however, there is limited data to guide how antibiotics should be adjusted in obese patients. Physiologic differences including an increased volume of distribution and increased renal clearance may alter their pharmacokinetics and pharmacodynamics and subsequently, their efficacy. For beta-lactams like piperacillin/tazobactam (pip/tazo) and cefepime, extended infusion (EI) maximizes the time above the minimum inhibitory concentration (MIC) for optimal bactericidal activity. This dosing strategy may help decrease variability in achieving the target time above MIC in this patient population and lead to more favorable outcomes. Methods This single-center, retrospective, pre-/post- analysis included patients with a body mass index (BMI) > 30 that received EI (infused over 4 hours) or intermittent infusion (II) (infused over 30 minutes) pip/tazo or cefepime between 2/1/2020-4/30/2020 and 2/1/2019-4/30/2019, respectively. The primary outcome was in-hospital, all-cause mortality. Secondary outcomes included clinical success rate and hospital length of stay (LOS). Results During the evaluation periods, 98 patients met inclusion criteria (EI, N=53; II, N=45). Mean BMI was not statistically different between groups (EI, 36.0 kg/m2 [30.1-46.3]; II, 36.5 kg/m2 [30-48]). There were no cases of mortality in either group. The mean LOS in the II group was 13 days compared to 11.5 days in the EI group [95% CI -4.14-7.04; p=0.606]. After excluding one outlier of 104 days in the EI group, the average LOS was 9.5 days [95% CI: -0.87-7.33; p=0.121]. Markers of clinical success including time to resolution of fever (II: 47 hours; EI: 34 hours; p=0.216) and time to resolution of leukocytosis (II: 2 days; EI: 3.8 days; p=0.089) were not significantly different between groups. Conclusion The use of EI pip/tazo and cefepime was not associated with any differences in in-hospital, all-cause mortality, hospital LOS, or clinical success when compared to the use of II pip/tazo and cefepime. The lack of significant differences between groups may be attributable to the small sample size limiting the ability to detect a difference, especially regarding hospital LOS. Disclosures All Authors: No reported disclosures

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Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-021-00248-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daiki Sakai ◽

Wataru Matsumiya ◽

Sentaro Kusuhara ◽

Makoto Nakamura

Keyword(s):

Candida Albicans ◽

Medical Records ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Patient Characteristics ◽

Antifungal Drugs ◽

Factors Associated ◽

Logistic Analysis ◽

Multivariate Logistic Analysis ◽

Systemic Antifungal Therapy

Abstract Purpose To evaluate the factors associated with the development of ocular candidiasis (OC) and ocular prognosis with echinocandin therapy for candidemia. Methods The medical records of 56 consecutive patients with a positive blood culture for Candida species between November 2016 and October 2019 were retrospectively reviewed. Information on patient characteristics, isolated Candida species, treatment details for candidemia, and ocular findings were extracted to identify factors associated with OC development. Results The leading pathogen of candidemia was Candida albicans (C.albicans) (41.1%). Of 56 patients, 18 (32.1%) were diagnosed with chorioretinitis, categorized as either probable (8 patients) or possible OC (10 patients). There was no case of endophthalmitis with vitritis. The incidence of probable OC was not significantly different between the groups treated with echinocandins and other antifungal drugs (15.2% vs. 11.1%, p = 1.00). In all probable OC cases, systemic antifungal therapy was switched from echinocandins to azoles, and no case progressed to endophthalmitis. A multivariate logistic analysis revealed that female sex (adjusted odds ratio [aOR], 8.93; 95% confidence interval [CI], 1.09–72.9) and C. albicans (aOR, 23.6; 95% CI, 1.8–281) were independent factors associated with the development of probable OC. Conclusion One-seventh of patients with candidemia developed probable OC. Given the evidence of female and C. albicans as the factors associated with OC development, careful ophthalmologic management is required with these factors, especially in candidemia. Although echinocandins had no correlation with OC development and did not lead to the deterioration of ocular prognosis, further investigation is required.

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Plasma Rivaroxaban Level to Identify Patients at Risk of Drug Overexposure: Is a Single Measurement of Drug Level Reliable?

TH Open ◽

10.1055/s-0040-1721734 ◽

2021 ◽

Vol 05 (01) ◽

pp. e84-e88

Author(s):

Krishnan Shyamkumar ◽

Jack Hirsh ◽

Vinai C. Bhagirath ◽

Jeffrey S. Ginsberg ◽

John W. Eikelboom ◽

...

Keyword(s):

At Risk ◽

Dose Reduction ◽

Dose Adjustment ◽

Trough Level ◽

Drug Level ◽

Single Measurement ◽

Risk Of Bleeding ◽

Level Measurement ◽

Patients At Risk ◽

Trough Levels

Abstract Introduction Dose adjustment based on laboratory monitoring is not routinely recommended for patients treated with rivaroxaban but because an association has been reported between high drug level and bleeding, it would be of interest to know if measuring drug level once could identify patients at risk of bleeding who might benefit from a dose reduction. Objective This study was aimed to investigate the reliability of a single measurement of rivaroxaban level to identify clinic patients with persistently high levels, defined as levels that remained in the upper quintile of drug-level distribution. Methods In this prospective cohort study of 100 patients with atrial fibrillation or venous thromboembolism, peak and trough rivaroxaban levels were measured using the STA-Liquid Anti-Xa assay at baseline and after 2 months. Values of 395.8 and 60.2 ng/mL corresponded to the 80th percentile for peak and trough levels, respectively, and levels above these cut-offs were categorized as high for our analyses. Results Among patients with a peak or trough level in the upper quintile at baseline, only 26.7% (95% confidence interval [CI]: 10.9–52.0%), and 13.3% (95% CI: 2.4–37.9%), respectively, remained above these thresholds. Conclusion Our findings do not support the use of a single rivaroxaban level measurement to identify patients who would benefit from a dose reduction because such an approach is unable to reliably identify patients with high levels.

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Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

Journal of Clinical Medicine ◽

10.3390/jcm10050928 ◽

2021 ◽

Vol 10 (5) ◽

pp. 928

Author(s):

Takuya Okugawa ◽

Tadayuki Oshima ◽

Keisuke Nakai ◽

Hirotsugu Eda ◽

Akio Tamura ◽

...

Keyword(s):

Risk Factors ◽

Medical Records ◽

Colorectal Polyp ◽

Control Group ◽

Single Center ◽

Antithrombotic Agents ◽

Delayed Bleeding ◽

Factors Associated ◽

Independent Risk Factors ◽

Continuous Use

Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6–2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection. Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared. Results: A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction. Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.

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