A Descriptive Report of Bleeding Complications Secondary to Warfarin Therapy

2003 ◽  
Vol 38 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Daphne Bernard ◽  
Arjun P. Dutta ◽  
Monika N. Daftary
Keyword(s):  
Medical Records ◽  
Chart Review ◽  
Warfarin Therapy ◽  
Common Factors ◽  
Retrospective Chart Review ◽  
Descriptive Statistics ◽  
Bleeding Complications ◽  
Comorbid Conditions ◽  
Factors Associated ◽  
Anticoagulation Intensity

Purpose This study identified factors that contributed to bleeding complications associated with warfarin therapy that were documented as adverse drug reactions (ADRs). Methods A retrospective chart review was performed using the Medical Records Department's “E” code list of anticoagulant-related ADRs. Descriptive statistics were used to identify common factors associated with bleeding complications related to warfarin use. Results Patients 60 years of age or older experienced 78% of all events; a majority (81%) of reports involved the presence of comorbid conditions such as congestive heart failure, carcinoma, or sepsis. A supratherapeutic INR was documented for 75% of patients with anticoagulant-related ADRS. Conclusions Age, comorbid conditions, and anticoagulation intensity were identified as possible factors contributing to documented ADRs associated with warfarin therapy.

Pegfilgrastim (Neulasta®) and Filgrastim (Neupogen®) Use in Patients Receiving Chemotherapy in Oncology Practices: Interim Results of the Assessment of Current CSF Evaluation for Proper Therapy (ACCEPT) Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5309-5309
Author(s):  
Luis Alberto Meza ◽  
Veena Charu ◽  
Roger Dansey ◽  
Fang Xie ◽  
Bradley Stolshek
Keyword(s):  
Solid Tumor ◽  
Medical Records ◽  
Interim Analysis ◽  
Cycle Length ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Factors Associated ◽  
Use Patterns ◽  
Early Primary ◽  
Tumor Types

Abstract Introduction: The pivotal trials of pegfilgrastim and filgrastim demonstrated their value as primary protection if initiated 24 hours after chemotherapy (CT) administration from CT cycle 1. Current clinical use patterns for pegfilgrastim and filgrastim may differ and may include primary protection in cycle (C) 1 or secondary protection in later cycles. Additionally, the initiation day within a CT cycle could be early (primary protection), late (reactive use), or for treatment of established neutropenia or febrile neutropenia (FN). A retrospective chart review is underway to determine current use patterns and applications of once-per-cycle pegfilgrastim (approved in 2002) and daily filgrastim. Methods: Patient (pt) medical records are being retrospectively collected from 100 randomly selected US private oncology practices. Eligible pts are ≥18 years of age, diagnosed with non-Hodgkin’s lymphoma (NHL), Hodgkin’s disease (HD), lung (LC), ovarian (OC), colorectal (CRC) or breast (BC) cancers, and have received ≥1 CT cycle. This planned interim analysis evaluates pegfilgrastim and filgrastim utilization in cancer pts receiving CT in 2003. Results: Medical records of 624 pts from 34 sites receiving pegfilgrastim or filgrastim have been abstracted to date. Pegfilgrastim was initiated in 351(56%) pts and filgrastim was initiated in 273 (44%) pts. Of the 624 pts, 120 (19%) received both pegfilgrastim and filgrastim (no pt used both products in the same cycle). Of these, 94 (78%) received pegfilgrastim after initially receiving filgrastim while 26 (22%) received filgrastim after initially receiving pegfilgrastim. The distribution of tumor types for the 325 pts receiving only pegfilgrastim was BC 43%; LC 24%; NHL 20%; HD 5%; OC 5%; CRC 3%. The planned CT cycle length (days) for pts receiving pegfilgrastim was: Q21 (56%), Q14 (11%), Q28 (11%), Q7 (2%). In C1, 58% of pts received pegfilgrastim; in C2, 86% received pegfilgrastim. In C1, pegfilgrastim was administered ≤3 days after CT in 76% (142/187) of pts and in 83% (200/240) of pts in C2. C1 use of pegfilgrastim was 68% for lymphoma and 54% for solid tumor pts. The distribution of tumor types for the 179 pts receiving only filgrastim was BC 46%; LC 24%; CRC 12%; NHL 9%; HD 6%; OC 4%. The planned CT cycle length (days) for pts receiving filgrastim was: Q21 (35%), Q28 (17%), Q14 (15%), Q7 (12%). In C1, 62% of pts received filgrastim; in C2, 83% received filgrastim. In C1, filgrastim was administered ≤3 days after CT in 31% (34/111) of pts increasing to 48% (52/108) of pts in C2. Filgrastim was initiated ≥10 days after CT in C1 in 48% (53/111) of pts and in 26% of pts (28/108) in C2. C1 use of filgrastim was 58% for lymphoma and 63% for solid tumor pts. Conclusions: From this interim analysis, most pts initiated pegfilgrastim in C1 and early within a cycle, suggesting primary protection. Most pts initiated filgrastim also in C1, however the day of initiation is much later, suggesting reactive use or treatment of established neutropenia or FN. Future analyses will evaluate factors associated with use (or non-use) of pegfilgrastim and filgrastim including baseline and treatment characteristics.

scholarly journals A retrospective chart review to identify perinatal factors associated with food allergies

2012 ◽  
Vol 11 (1) ◽  
Author(s):  
Kelly Dowhower Karpa ◽  
Ian M Paul ◽  
J Alexander Leckie ◽  
Sharon Shung ◽  
Nurgul Carkaci-Salli ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Food Allergies ◽  
Perinatal Factors ◽  
Factors Associated

scholarly journals Perioperative Intravenous Acetaminophen in Pediatric Tonsillectomies

2018 ◽  
Vol 53 (5) ◽  
pp. 316-320 ◽  
Author(s):  
Brandi Bowman ◽  
Leslie Sanchez ◽  
Preeyaporn Sarangarm
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Descriptive Statistics ◽  
Pain Medications ◽  
Frequent Administration ◽  
Intravenous Acetaminophen ◽  
Sparing Effect ◽  
Opiate Administration

Purpose: This study investigated the effect of perioperative intravenous (IV) acetaminophen on opioid requirements in pediatric patients undergoing tonsillectomy at a single center. Methods: This retrospective chart review included patients who were less than 18 years old and underwent an outpatient tonsillectomy procedure. Patients who received non–Food and Drug Administration (FDA)-approved dosing of IV acetaminophen, without documented weights, and on chronic pain medications at the time of the procedure were excluded. The primary outcome was opioid requirements postoperatively prior to discharge measured as morphine equivalents per kilogram. Descriptive statistics were used to compare differences between groups. A multivariate analysis was performed, accounting for differences between groups in baseline and procedural characteristics. Results: In total, 157 patients were included in this study, of whom 55 had received IV acetaminophen and 102 had not. The average IV acetaminophen dose for was 14.5 mg/kg for patients weighing less than 50 kg (n = 22); the remaining patients received the maximum 1 g dose. Patients who received IV acetaminophen were less likely to be administered postoperative opiates as compared with those did not (45.5% vs 63.7%, odds ratio = 0.48, P = .036). There was a trend toward a decrease in total amount of opiates administered with IV acetaminophen (0 vs 0.033 µg/kg, P = .61). After adjusting for age and documented pain assessment, IV acetaminophen administration remained a significant factor for postoperative opiate administration. Conclusions: Perioperative administration of IV acetaminophen was associated with less frequent administration of symptom-directed opiates in pediatric tonsillectomies. This finding indicates that the agent may have an opioid-sparing effect in this patient population.

scholarly journals P.075 Incidence of Stroke Associated With Antithrombotic Agent Interruption

2021 ◽  
Vol 48 (s3) ◽  
pp. S40-S40
Author(s):  
HE Snyder ◽  
A Cao ◽  
R Rana ◽  
L Li ◽  
F Masood
Keyword(s):  
Ischemic Stroke ◽  
Medical Records ◽  
Chart Review ◽  
Significant Proportion ◽  
Retrospective Chart Review ◽  
Primary And Secondary Prevention ◽  
Antithrombotic Agent ◽  
Healthcare Burden ◽  
Stroke Centre ◽  
Significant Mortality

Background: Antithrombotic medications are used in the primary and secondary prevention of ischemic stroke. Previous studies have identified that up to 5.2% of ischemic strokes are associated with antithrombotic interruption, leading to significant mortality and healthcare burden. Our study aims to identify the prevalence of ischemic strokes presenting to a regional stroke centre associated with antithrombotic interruption, and to understand common reasons for medication interruption. Methods: A retrospective chart review was performed, which included 193 patients with ischemic stroke presenting to Greater Niagara General Hospital from January 2018-December 2019. Baseline demographics were recorded and patient medical records were reviewed for evidence of antithrombotic interruptions. Results: Table 1. Conclusions: Our cohort identified a significant proportion (8.3%) of ischemic strokes with documented antithrombotic interruption. Most common reasons for interruption were non-adherence and discontinuation due to previous adverse event. The results identify possible areas for improvement within patient education and safe re-initiation of antithrombotics following adverse events.

scholarly journals Time in Therapeutic Range Using a Nomogram for Dose Adjustment of Warfarin in Patients on Hemodialysis With Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
pp. 205435812110460
Author(s):  
Kimberly Defoe ◽  
Jenny Wichart ◽  
Kelvin Leung
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Chart Review ◽  
Warfarin Therapy ◽  
Small Sample Size ◽  
Retrospective Chart Review ◽  
Small Sample ◽  
Time In Therapeutic Range ◽  
Increased Risk ◽  
Chi Square Analysis

Background: Patients treated with hemodialysis and prescribed warfarin typically have lower time in therapeutic range (TTR) compared to the general population. This may result in less benefit or increased risk of over anticoagulation in these patients. Objective: To assess effectiveness of use of an electronic nomogram for the management of warfarin therapy in patients treated with hemodialysis. Design: Retrospective chart review. Setting: Adult patients treated with hemodialysis. Patients: Patients on hemodialysis receiving warfarin for the management of atrial fibrillation (AF) with therapy managed by nursing led electronic nomogram. Measurements: Time in therapeutic range (as fraction and Rosendaal). Methods: Retrospective chart review over 1 year of international normalized ratio (INR) results was completed, and TTR was calculated. Comparison of patients with TTR greater than 60% to those less than 60% was completed using chi-square analysis. Results: Of 43 patients with warfarin therapy managed by the nomogram, the mean TTR was 55.2% (calculated by fraction method) or 61.2% (calculated by Rosendaal method). More than half of the patients (63.5%) had moderate to good control, defined as TTR greater than 60%. Female sex, liver disease, or history of substance use and more medication holds were associated with lower TTR. Limitations: Small sample size and retrospective nature of review. Conclusions: The results of this review supports the use of an electronic, nursing-led nomogram for the maintenance management of warfarin therapy in stable patients treated with hemodialysis, as use results in TTR greater than 60% for more than half of patients.

scholarly journals Serum magnesium levels in hospitalized patients with SARS-CoV-2

2021 ◽  
pp. jim-2021-001948
Author(s):  
Rupam Sharma ◽  
Arash Heidari ◽  
Royce H Johnson ◽  
Shailesh Advani ◽  
Greti Petersen
Keyword(s):  
Disease Severity ◽  
Chart Review ◽  
Medical Literature ◽  
Adverse Outcome ◽  
Serum Magnesium ◽  
Retrospective Chart Review ◽  
Descriptive Statistics ◽  
Ventilator Support ◽  
Adjusted Logistic Regression ◽  
Electrolyte Abnormalities

Early studies have reported various electrolyte abnormalities at admission in patients with severe COVID-19. 104 out of 193 patients admitted to our institution presented with hypermagnesemia at presentation. It is believed this may be important in the evaluation of severe SARS-CoV-2 infections. This study evaluated the outcomes of hypermagnesemia in patients with COVID-19. A retrospective chart review of patients admitted to the hospital with confirmed SARS-CoV-2 infection was conducted. A review of the medical literature regarding hypermagnesemia, magnesium levels in critical care illness and electrolyte abnormalities in patients with COVID-19 was performed. Differences in demographic and clinical characteristics of patients with hypermagnesemia and normomagnesemia were evaluated using descriptive statistics. Other known variables of disease severity were analyzed. 104 patients (54%) were identified with hypermagnesemia (≥2.5 mg/dL). 48 of those patients were admitted to the intensive care unit (46%, p<0.001). 34 patients required ventilator support (32%, p<0.0001). With age-adjusted logistic regression analysis hypermagnesemia was associated with mortality (p=0.007). This study demonstrates that hypermagnesemia is a significant marker of disease severity and adverse outcome in SARS-CoV-2 infections. We recommend serum magnesium be added to the panel of tests routinely ordered in evaluation of severe SARS-CoV-2 infections.

scholarly journals Exploring the experience of boarded psychiatric patients in adult emergency departments

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Major ◽  
Katherine Rittenbach ◽  
Frank MacMaster ◽  
Hina Walia ◽  
Stephanie D. VandenBerg
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Psychiatric Patients ◽  
Retrospective Chart Review ◽  
Factors Associated ◽  
Time Period ◽  
Patient Will ◽  
Independent Variable ◽  
Inpatient Psychiatric Unit ◽  
Significant Factors

Abstract Background This study quantifies the frequency of adverse events (AEs) experienced by psychiatric patients while boarded in the emergency department (ED) and describes those events over a broad range of categories. Methods A retrospective chart review (RCR) of adult psychiatric patients aged 18–55 presenting to one of four Calgary EDs (Foothills Medical Centre (FMC), the Peter Lougheed Centre (PLC), the Rockyview General Hospital (RGH), and South Health Campus (SHC)) who were subsequently admitted to an inpatient psychiatric unit between January 1, 2019 and May 15, 2019 were eligible for review. A test of association was used to determine the odds of an independent variable being associated with an adverse event. Results During the study time period, 1862 adult patients were admitted from EDs (city wide) to the psychiatry service. Of the 200 charts reviewed, the average boarding time was 23.5 h with an average total ED length of stay of 31 h for all presentations within the sample. Those who experienced an AE while boarded in the ED had a significantly prolonged average boarding time (35 h) compared to those who did not experience one (6.5 h) (p = 0.005). Conclusions The length of time a patient is in the emergency department and the length of time a patient is boarded after admission significantly increases the odds that the patient will experience an AE while in the ED. Other significant factors associated with AEs include the type of admission and the hospital the patient was admitted from.

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