Looking at this trial of CDT vs. anticoagulation alone, the results look significant with a win for catheter directed thrombolysis, with lower incidence of the primary outcome (decompensation, death or recurrence of PE) and a slight increase in major bleeding...
But what happens if we combine the primary efficacy outcome and the primary safety outcome to encompass all patients with "good" or "bad" (death, decompensation, recurrence or bleeding) outcomes?
That means 8.1% of CDT patients had a bad outcome, vs. 12.5% with anticoagulation alone (p = 0.085), making CDT no better than anticoagulation alone! #NEJM #medtwitter
Mike Erdman retweeted
What causes acute kidney injury?
Well, the list is long.... but IV contrast is not one of them.
We reviewed 13 studies (9 retrospective, 4 prospective), which included 25,950 patients. Based on currently available data, CA-AKI is not a thing.
Check out our review for more details.
jem-journal.com/article/S073…
@long_brit
@MGottliebMD
#emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #data #research #army #armymedicine #armyemdoc #resuscitation #kidney #nephrology #bean #medx #medtwitter
Mike Erdman retweeted
Tons of NEW DATA about andexanet, presented as part of FDA hearing last week. If you couldn’t make it through the short 6h meeting, GOOD NEWS, I’ve watched it and highlighted the important points.
A🧵
Mike Erdman retweeted
You may have heard that AA is "less expensive" than 4PCC for reversal when you take into account the "entire cost of the hospitalization bc the outcomes are better"
This slide (from AZ) shows that "data". It's from a 2020 ASHP Poster.
1/2
Mike Erdman retweeted
A summary of "Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage" (ANNEXA-I) by Stuart Connolly et al NEJM:
1. 🔬 Study Purpose: Evaluated the effectiveness of andexanet alfa in controlling hematoma expansion in patients with intracerebral hemorrhage on factor Xa inhibitors.
2. 🧪 Methods: 530 patients were randomly assigned to receive either andexanet or usual care, with primary endpoints being hemostatic efficacy and safety endpoints like thrombotic events and death.
3. 📊 Results: Andexanet achieved better control of hematoma expansion (67.0%) compared to usual care (53.1%), but it increased thrombotic events (10.3% vs. 5.6%).
4. 💉 Treatment Efficacy: The median reduction in anti–factor Xa activity was significantly higher with andexanet (94.5%) compared to usual care (26.9%).
5. ⚠️ Safety Concerns: While effective in controlling hematoma expansion, andexanet was associated with a higher risk of thrombotic events, including ischemic stroke.
#CODE #ICH
nejm.org/doi/full/10.1056/NE…
Pro tip: if you see a pro-AA statement on here, Google the author name + disclosure and see how many have AZ connections
Mike Erdman retweeted
Is anaerobic coverage necessary for aspiration pneumonia with metronidazole or Augmentin?
NEJM JWatch reports from a large retro study with N ~ 4000
Findings show no added mortality benefit but an increased risk of CDI
journal.chestnet.org/article…
#IDTwitter #IDXposts
Mike Erdman retweeted
Things We Do for No Reason™: Furosemide‐albumin coadministration for diuretic resistance - Vipler - Journal of Hospital Medicine - Wiley Online Library shmpublications.onlinelibrar…
Mike Erdman retweeted
Consensus Statement Advocates for Immediate Change to Intracerebral Hemorrhage Protocols
#CodeICH
neurologylive.com/view/conse… via @neurology_live
Mike Erdman retweeted
#STROKE Special Report by Li and Yakhkind et al.: "Code ICH: A Call to Action" — an emergency pathway for ICH patients that facilitates rapid delivery of bundled treatments. #AHAJournals ahajournals.org/doi/10.1161/…
Mike Erdman retweeted
📻 Looking for a pharmacy residency program in 🌞Florida🌴 @ a large academic medical center? 💊
✔️ all the boxes @ UF Health Jacksonville 🐊
#ashp #pharmacy
Visit our website to find detailed information on the application process: ufhealthjax.org/pharmacy-res…
Mike Erdman retweeted
Announcement🥳:
🐊💊PGY-2 Infectious Diseases 🦠🔬 will be going to the ASHP match. Limited spots during PPS, so book your PPS ASAP. 🛬
Not making it to Midyear, set-up a virtual visit, contact us here to start the virtual process! 💻ufhealthjax.org/pharmacy-res… #TwitterX #IDTwitter
So if you had an anticoagulant reversal medication that stopped hematoma expansion, but had no effect on 30-day outcomes, and had a 4x increased risk of ischemic stroke, would you give it?
#ANNEXa_I
8%Yes
92%No
385 votes • Final resultsIt's now been 4 months since @AstraZeneca published a press release saying ANNEXA-I was stopped...still no published results (though we did get some new graphics from the rep)👀
Mike Erdman retweeted
Join us next Tuesday, Oct. 10 on X for a discussion about the @NeurocritCareJ article "Safety & Efficacy of Ketamine Without Intubation in the Management of Refractory Seizures." Questions begin at 9 a.m. CT & will be posted hourly. Read the article now: ow.ly/Quz350PSGlR
