scholarly journals Evaluation of the Clinical Impact of Thromboprophylaxis in Patients With COVID-19 Following Hospital Discharge

2022 ◽  
pp. 106002802110643
Author(s):  
Lindsay A. Courtney ◽  
Toby C. Trujillo ◽  
Joseph J. Saseen ◽  
Garth Wright ◽  
Surabhi Palkimas
Keyword(s):  
Hospital Discharge ◽  
Thromboembolic Event ◽  
Primary Outcome ◽  
Bleeding Event ◽  
Secondary Outcome ◽  
Bleeding Events ◽  
Post Discharge ◽  
University Of Colorado ◽  
Discharge Outcomes

Background: Data are limited regarding the incidence of thromboembolism post-hospital discharge among COVID-19 patients. Guidelines addressing the role of extended thromboprophylaxis for COVID-19 patients are limited and conflicting. Objective: The purpose of this study was to evaluate the incidence of post-discharge thromboembolic and bleeding events and the role of thromboprophylaxis among COVID-19 patients. Methods: A retrospective analysis was conducted of hospitalized patients with symptomatic COVID-19 infection who were discharged from a University of Colorado Health (UCHealth) hospital between March 1, 2020, and October 31, 2020. The primary outcome was objectively confirmed thromboembolism within 35 days post-discharge. The main secondary outcome was the incidence of bleeding events within 35 days post-discharge. Outcomes were compared between those who received extended prophylaxis and those who did not. Results: A total of 1171 patients met the study criteria. A total of 13 (1.1%) of patients had a documented thromboembolic event and 10 (0.9%) patients had a documented bleeding event within 35 days post-discharge. None of the 132 patients who received extended prophylaxis had a thromboembolic event compared to 13 of 1039 who did not receive extended prophylaxis (0 and 1.3%, respectively; P = .383). The incidence of bleeding was higher among patients who received extended prophylaxis compared to those who did not (3.0% vs 0.6%, P = .019). Conclusions and Relevance: These results suggest that post-discharge extended prophylaxis may be beneficial for select COVID-19 patients, while carefully weighing the risk of bleeding. Application of our findings may assist institutions in development of thromboprophylaxis protocols for discharged COVID-19 patients.

scholarly journals Role of Preoperative Calcium and Vitamin D Therapy to prevent Post-thyroidectomy Hypocalcemia

2020 ◽  
Author(s):  
Sunghwan suh ◽  
Ju Won Seok ◽  
Keunyoung Kim ◽  
Mi Kyoung Park ◽  
Kyoungjune Pak ◽  
...  
Keyword(s):  
Vitamin D ◽  
English Language ◽  
Primary Outcome ◽  
Potential Role ◽  
Meta Analysis ◽  
Vitamin D Supplementation ◽  
Secondary Outcome ◽  
Significant Difference ◽  
Symptomatic Hypocalcemia

Abstract Purpose: Postsurgical hypocalcemia is the most common and troublesome consequence of thyroidectomy. We investigated the potential role of routine calcium or vitamin D supplementation in preventing postsurgical hypocalcemia. Materials and Methods: We searched MEDLINE and EMBASE for English-language publications using the keywords “calcium”, “vitamin D”, and “thyroid cancer”. The primary outcome was any postoperative hypocalcemia, and the secondary outcome was symptomatic hypocalcemia. Results: Four studies that included 381 patients were eligible for this meta-analysis. The random-effects model showed no significant difference in the occurrence of hypocalcemia between calcium/vitamin D treatment and placebo/no treatment. The occurrence of symptomatic hypocalcemia was lower in patients with calcium/vitamin D treatment. In combined results, preoperative calcium and vitamin D supplementation was associated with a reduced incidence of symptomatic hypocalcemia.Conclusion: We support the use of preoperative calcium and vitamin D supplementation in conjunction with routine postsurgical supplementation for patients after total thyroidectomy.

scholarly journals Personality predictors of emergency department post-discharge outcomes

2021 ◽  
Vol 2 ◽  
Author(s):  
Olivia E. Atherton ◽  
Emily C. Willroth ◽  
Ted Schwaba ◽  
Ayla J. Goktan ◽  
Eileen K. Graham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Personality Traits ◽  
Big Five ◽  
Care Physician ◽  
Big Five Personality ◽  
Urban Hospital ◽  
Post Discharge ◽  
Personality Predictors ◽  
Discharge Outcomes

Personality traits are important predictors of health behaviors, healthcare utilization, and health outcomes. However, we know little about the role of personality traits for emergency department outcomes. The present study used data from 200 patients (effective Ns range from 84 to 191), who were being discharged from the emergency department at an urban hospital, to investigate whether the Big Five personality traits were associated with post-discharge outcomes (i.e., filling prescriptions, following up with primary care physician, making an unscheduled return to the emergency department). Using logistic regression, we found few associations among the broad Big Five domains and post-discharge outcomes. However, results showed statistically significant associations between specific Big Five items (e.g., “responsible”) and the three post-discharge outcomes. This study demonstrates the feasibility of assessing personality traits in an emergency medicine setting and highlights the utility of having information about patients’ personality tendencies for predicting post-discharge compliance.

Role of echocardiographic scoring systems in predicting successful biventricular versus univentricular palliation in neonates with critical aortic stenosis

2020 ◽  
Vol 30 (11) ◽  
pp. 1702-1707
Author(s):  
Shagun Sachdeva ◽  
Evelyn Kuhn ◽  
Peter C. Frommelt ◽  
Stephanie Handler
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Hospital Discharge ◽  
Primary Outcome ◽  
Scoring Systems ◽  
Balloon Valvuloplasty ◽  
Local Approach ◽  
Discharge Data ◽  
Critical Aortic Stenosis

AbstractBackground:There are several published echo-derived scores to help predict successful biventricular versus univentricular palliation in neonates with critical aortic stenosis. This study aims to determine whether any published scoring system accurately predicted outcomes in these neonates.Methods:Single centre, retrospective cohort study including neonates who underwent aortic valve intervention (surgical valvotomy or balloon valvuloplasty) with the intention of biventricular circulation. Primary outcome was survival with biventricular circulation at hospital discharge. Data from their initial neonatal echocardiogram were used to compute the following scores – Rhodes, CHSS 1, Discriminant, CHSS 2, and 2 V.Results:Between 01/1999 and 12/2017, 68 neonates underwent aortic valve intervention at a median age of 4 days (range 1–29 days); 35 surgical valvotomy and 33 balloon valvuloplasty. Survival with biventricular circulation was maintained in 60/68 patients at hospital discharge. Of the remaining eight patients, three were converted to univentricular palliation, four died, and one underwent heart transplant prior to discharge. None of the binary score predictions of biventricular versus univentricular (using that score’s proposed cut-offs) were significantly associated with the observed outcome in this cohort. A high percentage of those predicted to need univentricular palliation had successful biventricular repair: 89.4% by Rhodes, 79.3% by CHSS 1, 85.2% by Discriminant, and 66.7% by CHSS 2 score. The 2 V best predicted outcome and agreed with the local approach in most cases.Conclusion:This study highlights the limitations of and need for alternative scoring systems/cut-offs for consistently accurate echocardiographic prediction of early outcome in neonates with critical aortic stenosis.

Abstract 16415: Switching of ADP Receptor Inhibitor After Hospital Discharge Among Myocardial Infarction Patients: Insights From the TRANSLATE-ACS Observational Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marjorie E Zettler ◽  
Eric D Peterson ◽  
Lisa A McCoy ◽  
Mark B Effron ◽  
Kevin J Anstrom ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bleeding Event ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
First Year ◽  
Severe Bleeding ◽  
Bleeding Events ◽  
Post Discharge ◽  
Before And After ◽  
Adp Receptor

Background: With the availability of several ADP receptor inhibitors (ADPri), switching between agents is known to occur. However, among myocardial infarction (MI) patients treated with percutaneous coronary intervention (PCI), the incidence and patterns of post-discharge ADPri switching are unknown. Methods: Using data from the TRANSLATE-ACS study (2010-2012), we assessed the incidence of post-discharge ADPri switching among 8672 MI patients who were discharged after PCI and remained on ADPri therapy through 1 year post-MI. We examined bleeding and major adverse cardiovascular events (MACE: MI, stroke, unplanned revascularization) within 7 days before and after switching. Results: During the first year after index MI discharge, 663 patients (7.6%) had a switch in ADPri; switching occurred at a median of 50 days (IQR 7-154) post-discharge. Switching occurred most frequently in patients discharged on ticagrelor (64/226, 28.3%), then prasugrel (383/2489, 15.4%), and clopidogrel (216/5957, 3.6%, p<0.001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel; 87.5% of ticagrelor switches were to clopidogrel. Among clopidogrel patients who switched, 55 (25.5%) had a MACE event in the 7 days preceding switch. Among prasugrel and ticagrelor patients who switched, a GUSTO moderate/severe bleeding event occurred in 5 (1.3%) and 1 (1.5%) patients, respectively, in the 7 days preceding switch. Patients switched from prasugrel or ticagrelor most often cited cost as a reason for the switch (43.6% and 39.1%, respectively), while 60.7% of patients switched from clopidogrel attributed the switch to a physician decision. In the week following a switch, both MACE and major bleeding events were infrequent (table). Conclusions: ADPri switching occurred infrequently within the first year post-MI. Switching occurred more commonly among patients discharged on higher potency ADPri, but only a minority of these switches were triggered by bleeding.

scholarly journals Effect of bromhexine in hospitalized patients with COVID-19

2021 ◽  
pp. jim-2020-001747
Author(s):  
Ramin Tolouian ◽  
Zuber D Mulla ◽  
Hamidreza Jamaati ◽  
Abdolreza Babamahmoodi ◽  
Majid Marjani ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Clinical Improvement ◽  
Primary Outcome ◽  
Adverse Drug Events ◽  
Antiviral Effect ◽  
Hospitalized Patients ◽  
Secondary Outcome ◽  
Risk Of Death ◽  
Significant Difference ◽  
Transmembrane Serine Protease

BackgroundBromhexine is a potent inhibitor of transmembrane serine protease 2 and appears to have an antiviral effect in controlling influenza and parainfluenza infection; however, its efficacy in COVID-19 is controversial.MethodsA group of hospitalized patients with confirmed COVID-19 pneumonia were randomized using 1:1 allocation to either standard treatment lopinavir/ritonavir and interferon beta-1a or bromhexine 8 mg four times a day in addition to standard therapy. The primary outcome was clinical improvement within 28 days, and the secondary outcome measures were time to hospital discharge, all-cause mortality, duration of mechanical ventilation, the temporal trend in 2019-nCoV reverse transcription-polymerase chain reaction positivity and the frequency of adverse drug events within 28 days from the start of medication.ResultsA total of 111 patients were enrolled in this randomized clinical trial and data from 100 patients (48 patients in the treatment arm and 52 patients in the control arm) were analyzed. There was no significant difference in the primary outcome of this study, which was clinical improvement. There was no significant difference in the average time to hospital discharge between the two arms. There were also no differences observed in the mean intensive care unit stay, frequency of intermittent mandatory ventilation, duration of supplemental oxygenation or risk of death by day 28 noted between the two arms.ConclusionBromhexine is not an effective treatment for hospitalized patients with COVID-19. The potential prevention benefits of bromhexine in asymptomatic postexposure or with mild infection managed in the community remain to be determined.

scholarly journals Pre-medication with oral anticoagulants is associated with better outcomes in a large multinational COVID-19 cohort with cardiovascular comorbidities

2021 ◽  
Author(s):  
Marina Rieder ◽  
Nadine Gauchel ◽  
Klaus Kaier ◽  
Carolin Jakob ◽  
Stefan Borgmann ◽  
...  
Keyword(s):  
Oral Anticoagulants ◽  
Thrombotic Event ◽  
Bleeding Event ◽  
Secondary Outcome ◽  
Bleeding Events ◽  
Timely Initiation ◽  
Course Of Disease ◽  
Cardiovascular Comorbidities ◽  
Secondary Endpoints ◽  
Related Mortality

Abstract Aims Coagulopathy and venous thromboembolism are common findings in coronavirus disease 2019 (COVID-19) and are associated with poor outcome. Timely initiation of anticoagulation after hospital admission was shown to be beneficial. In this study we aim to examine the association of pre-existing oral anticoagulation (OAC) with outcome among a cohort of SARS-CoV-2 infected patients. Methods and results We analysed the data from the large multi-national Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS) from March to August 2020. Patients with SARS-CoV-2 infection were eligible for inclusion. We retrospectively analysed the association of pre-existing OAC with all-cause mortality. Secondary outcome measures included COVID-19-related mortality, recovery and composite endpoints combining death and/or thrombotic event and death and/or bleeding event. We restricted bleeding events to intracerebral bleeding in this analysis to ensure clinical relevance and to limit reporting errors. A total of 1 433 SARS-CoV-2 infected patients were analysed, while 334 patients (23.3%) had an existing premedication with OAC and 1 099 patients (79.7%) had no OAC. After risk adjustment for comorbidities, pre-existing OAC showed a protective influence on the endpoint death (OR 0.62, P = 0.013) as well as the secondary endpoints COVID-19-related death (OR 0.64, P = 0.023) and non-recovery (OR 0.66, P = 0.014). The combined endpoint death or thrombotic event tended to be less frequent in patients on OAC (OR 0.71, P = 0.056). Conclusions Pre-existing OAC is protective in COVID-19, irrespective of anticoagulation regime during hospital stay and independent of the stage and course of disease. Graphic abstract

Effectiveness and Safety of Twice- Versus Thrice-Daily Subcutaneous Heparin for Venous Thromboembolism Prophylaxis at a Large Academic Medical Center

2021 ◽  
pp. 106002802110413
Author(s):  
Eryne E. Wiethorn ◽  
Sarah Harrison ◽  
Erin R. Weeda ◽  
Carolyn Magee Bell
Keyword(s):  
Venous Thromboembolism ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Secondary Outcome ◽  
Bleeding Events ◽  
Thromboembolism Prophylaxis ◽  
Vein Thrombosis ◽  
Venous Thromboembolism Prophylaxis ◽  
Deep Vein

Background Dosing variation of subcutaneous unfractionated heparin (UFH) exist for venous thromboembolism prophylaxis (VTEP). Objective The purpose of this study was to compare the safety and effectiveness of thrice-daily (TID) versus twice-daily (BID) administration of UFH during a heparin shortage for VTEP. Methods A single-center retrospective analysis was conducted in patients with orders for BID subcutaneous UFH during a heparin shortage from September 1, 2019, to February 4, 2020. These patients were matched to patients with TID subcutaneous UFH orders from January 1, 2019, to May 31, 2019. The primary outcome was the incidence of deep-vein thrombosis or pulmonary embolism confirmed by imaging during hospitalization. The secondary outcome was the incidence of major or clinically relevant nonmajor bleeding events as defined by International Society on Thrombosis and Haemostasis (ISTH) definitions. Results A total of 277 patients with orders for BID UFH and meeting inclusion criteria were evaluated and matched to patients who received TID UFH. After the exclusion criteria were implemented, 510 patients remained in the TID group. The primary outcome occurred in 4% of patients in the BID group and 3% in the TID group ( P = 0.645). Major bleeding or clinically relevant nonmajor bleeding events occurred in 10% of patients in the BID group and 8% in the TID group ( P = 0.310). Conclusion and Relevance There was no difference in effectiveness or safety of TID versus BID subcutaneous UFH for VTEP. During a heparin shortage, transitioning patients to BID UFH for VTEP to conserve supply may be considered.

scholarly journals Effect of Pharmacist Clinic Visits on 30-Day Heart Failure Readmission Rates at a County Hospital

2018 ◽  
Vol 54 (6) ◽  
pp. 358-364
Author(s):  
Lucy Hahn ◽  
Matthew Belisle ◽  
Sarah Nguyen ◽  
Kristin Snackey Alvarez ◽  
Sandeep Das
Keyword(s):  
Heart Failure ◽  
Hospital Discharge ◽  
High Intensity ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Readmission Rates ◽  
Medication Therapy ◽  
Low Intensity ◽  
Collaborative Practice Agreement ◽  
Clinic Visits

Purpose: This study evaluated the comparative effectiveness of different pharmacist visit types on reducing readmission rates. Method: A single-center, retrospective cohort study was conducted from January 2015 to July 2017. Patients were 18 years or older with an index heart failure (HF) exacerbation admission. Upon hospital discharge, patients were seen in clinic by a clinical pharmacy specialist (CPS) with collaborative practice agreement (CPA) (High Intensity Bundle), medication therapy management (MTM) pharmacist without CPA (Low Intensity Bundle), or no pharmacist (Standard of Care [SOC]). The primary outcome was 30-day all-cause readmission rate. Secondary outcomes included rate of 30-day HF readmissions and average number of days until readmission in those who were readmitted. Results: Totally, 98 patients were included in the final analysis (35 High Intensity Bundle, 28 Low Intensity Bundle, and 35 SOC). The primary outcome of all-cause readmissions was lower in both the pharmacist groups compared with SOC (CPS 8.6% [3/35] vs SOC 25.7% [9/35], P = 0.046 and MTM 7.1% [2/28] vs SOC 25.7% [9/35], P = 0.057). Incremental differences were seen between visit types for the secondary outcome of 30-day HF readmissions (CPS 2.9% vs MTM 7.1% vs SOC 17.1%, P = 0.039). The average number of days until readmission was longer in the CPS versus the MTM and SOC (26.7 days vs 12.5 days vs 14.1 days, respectively). Conclusion: Post-hospital discharge pharmacist visits were associated with lower 30-day all-cause readmission. In particular, clinic visits with a Higher Intensity Bundle may be more effective in reducing HF readmissions. These exploratory findings warrant further investigation.

scholarly journals Adherence to Prescribed Acamprosate in Alcohol Dependence and 1-Year Morbidities and Mortality: Utilizing a Data Linkage Methodology

2021 ◽  
Vol 10 (10) ◽  
pp. 2102
Author(s):  
Serenella Tolomeo ◽  
Alex Baldacchino
Keyword(s):  
Alcohol Dependence ◽  
Health Informatics ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
First Year ◽  
Increased Risk ◽  
One Year ◽  
Mortality Hazard Ratio ◽  
Dispensing Data

Objectives: We tested the hypothesis that poor adherence is associated with a greater risk of alcohol-caused mortality and morbidities within the first year of discontinuing this medication. Materials and Methods: A retrospective cohort study of 3319 individuals who received acamprosate in the East of Scotland in a 10-year period was conducted using a health informatics approach with record linkage of dispensing data, hospital utilization (SMR) and General Register Office of Scotland (GROS) data. The primary outcome was adherence between one to six months after initiating acamprosate medication. The secondary outcome was all-cause morbidities and mortality. Results: Of the total 3319 individuals identified, a good adherence index of >80% was found in 59% of those prescribed acamprosate after three months and 6% after six months. There were significant linear trends of poorer adherence with increased risk of alcohol-caused mortality (Hazard Ratio, HR 1.2), medical morbidities especially neoplasm (HR 4.1) and poisoning (HR 1.4), and psychiatric morbidities especially stress (HR 35.1), psychotic (HR 5.6) and neurotic disorders, and directly alcohol induced conditions (7.4 HR) after adjustment for other factors within a one-year period of initiation of acamprosate treatment. Discussion and Conclusions: Further exploratory studies using this digitalized approach should be encouraged in order to capture role of compliance to acamprosate and other types of medication that are known to reduce relapse into alcohol dependence and its direct relationship to mortality and morbidities in this population.

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