Heparin-Induced Thrombocytopenia – Stuart

HIT occurs in 5% of patients exposed to heparin. Etiology:  Autoantibody to PF4-heparin complex. More common with UFH, in women, and with surgery. Thrombocytopenia is noted in 90%, thrombosis in 50%. Dx:  Lab:  HIT antibody testing:  PF4 antibody, IgG Clinical Dx:  Four T Score: 4 T's score [From UpToDate, 4/21/17]:  Calculating the score — The 4 T's… Continue reading Heparin-Induced Thrombocytopenia – Stuart

Advertisements

Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

ITP is an acquired disorder of platelets:  consider as either increased destruction or decreased production. Classified as primary (a dx of exclusion) vs secondary. Etiology:  Caused by anti-platelet IgG directed against membrane proteins of the platelets. Inciting events:  infection vs immune alteration.. Incidence:  highest in children, and increased incidence with increased age in adult. DDx:… Continue reading Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

Daily Hemoglobin Measurement Usually Unnecessary in Inpatients

More evidence supporting elimination of "routine" inpatient labs! For hospitalized patients: repeat hemoglobin testing within a 24-hour period is of little valueClinical Question:Is it useful to repeat a hemoglobin test within a single calendar day for a hospitalized patient? Bottom Line:In this study, repeat hemoglobin testing within a 24-hour period for hospitalized patients showed a… Continue reading Daily Hemoglobin Measurement Usually Unnecessary in Inpatients

Active Surveillance for Localized Prostate Cancer: No increased mortality, but higher progression

Active surveillance for localized prostate CA: no increased mortality, buthigher rates of clinical progression (ProtecT)Clinical Question:What is the best approach to the management of localized prostate cancer? Bottom Line:This landmark study compared active surveillance (AS) with radical prostatectomy or radiation therapy for patients with T1c or T2 prostate cancer. The benefits of AS include avoiding… Continue reading Active Surveillance for Localized Prostate Cancer: No increased mortality, but higher progression

4Ts Score for Heparin-Induced Thrombocytopenia

The 4Ts score predicts pretest risk for heparin-induced thrombocytopenia. Cuker A, Gimotty PA, Crowther MA, Warkentin TE. Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis. Blood. 2012 Nov 15. 120(20):4160-7.  Feature Score 2 points 1 point 0 points Thrombocytopenia >50% fall and platelet nadir 20-100 × 109/L 30%-50%… Continue reading 4Ts Score for Heparin-Induced Thrombocytopenia

Direct Oral Anticoagulants vs Vitamin K Antagonists in Chronic Renal Failure

​Ann Intern Med. 2016;165:JC43. doi:10.7326/ACPJC-2016-165-8-043 This systematic review and meta-analysis examined 9 randomized, controlled trials comparing direct oral anticoagulants (DOACs) with warfarin (with or without a lovenox bridge) in patients with atrial fibrillation or venous thromboembolism. It found that DOACs are associated with less intracranial hemorrhage than warfarin in patients with creatine clearance (CrCl) levels… Continue reading Direct Oral Anticoagulants vs Vitamin K Antagonists in Chronic Renal Failure

Active Surveillance a Reasonable Alternative in Localized Prostate Cancer

Active surveillance = serial PSAs, DREs and prostate biopsies n = 1298 men over 20 years, Johns Hopkins study Inclusion:  very-low-risk (T1c, PSA density < 0.15, Gleason < 6, 2 or fewer positive bx cores, < 50% of core involved) or low-risk (<T2a, PSA <10, Gleason <6). All pts underwent semi-annual PSA, DRE, annual bx.… Continue reading Active Surveillance a Reasonable Alternative in Localized Prostate Cancer

USPSTF 2016: Aspirin for Primary Prevention of Cardiovascular Disease and Colorectal Cancer

Pearls from HippoEd's Primary Care RAP (November 2016): Low dose aspirin daily 81mg is used to provide primary prevention of CV disease (stroke and MI) and colon cancer. USPSTF in April 2016 release new guidelines that recommended (Grade B) low dose aspirin for all adults aged 50-59 who met the following criteria: 10% or greater… Continue reading USPSTF 2016: Aspirin for Primary Prevention of Cardiovascular Disease and Colorectal Cancer