Reviews of Research on Haloperidol and ICU Delirium, Proton Pump Inhibitors, Thrombolytics and Stroke

The Hospitalist. 2013 December;2013(12):

December 1, 2013|B-Cell Lymphoma ICYMI

Ethan Cumbler, MD;Jennifer Simpson, MD;Anunta Virapongse, MD;Annukka Antar, MD, PhD;Zuzanna Czernik, MD;Carmella Nogar;Christopher King, MD;Christine Jones, MD

Setting: Patient information from 1998 to 2012 from 10 European stroke centers.

Synopsis: A total of 6,856 patients were included, of which 19% received thrombolysis in <90 minutes. None of the patients received endovascular treatment for stroke. Modified Rankin score, a functional assessment, was used to determine outcome. A score of 0 or 1, an “excellent” outcome, was seen more often in patients with a moderate severity stroke (NIH stroke scale of 7-12) who received thrombolysis in <90 minutes, but not in other groups. Thrombolysis in <90 minutes was associated with fewer intracerebral hemorrhages (ICH), but symptomatic ICH was not statistically significantly different. Mortality at three months was not different in the two time groups.

Limitations to this study included an unknown presumed cause of stroke in more than a quarter of patients. Deviations from acute stroke protocols are not described. This study adds to the body of literature supporting the early use of intravenous thrombolysis in eligible acute stroke patients.

Bottom line: Expedient treatment with intravenous thrombolysis should occur in acute stroke patients.

Citation: Strbian D, Ringleb P, Michel P, et al. Ultra-early intravenous stroke thrombolysis: do all patients benefit similarly? Stroke. 2013;44(10):2913-2916.

Clinical Shorts

FLUOROQUINOLONES CAN CAUSE BOTH HYPOGLYCEMIA AND HYPERGLYCEMIA IN DIABETIC PATIENTS

A large cohort study showed an increased rate of both hypo- and hyperglycemia in diabetic patients treated with fluoroquinolones vs. macrolides; of the fluoroquinolones used, moxifloxacin was the worst offender.

Citation: Chou HW, Wang JL, Chang CH, Lee JJ, Shau WY, Lai MS. Risk of severe dysglycemia among diabetic patients receiving levofloxacin, ciprofloxacin, or moxifloxacin in Taiwan. Clin Infect Dis. 2013;57(7):971–980.

INTRAVENOUS IRON: BENEFITS AND HARMS

Meta-analysis shows IV iron increases hemoglobin levels and reduces the need for red blood cell transfusion in patients with iron deficiency anemia. However, IV iron also increased risk of infection.

Citation: Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomized clinical trials. BMJ. 2013;347:f4822.

PATIENTS THINK PLACEBOS ARE APPROPRIATE IN SOME SITUATIONS

In patient surveys, placebos could be appropriate if no harm occurred and if the physicians gave honest opinions about placebos. Two thirds of patients would consider a placebo in some instances.

Citation: Hull SC, Colloca L, Avins A, et al. Patients’ attitudes about the use of placebo treatments: telephone survey. BMJ. 2013;347:f3757.

NEW ORAL ANTICOAGULANTS EFFECTIVE FOR THROMBOPROPHYLAXIS AFTER TOTAL HIP AND TOTAL KNEE REPLACEMENT

A metasynthesis of six reviews concludes that oral factor Xa inhibitors and direct thrombin inhibitors are effective after TKA-THA; compared to LMWH, the factor Xa inhibitors’ marginal clinical benefits are offset by their increased risk for bleeding.

Citation: Adam SS, McDuffie JR, Lachiewicz PF, Ortel TL, Williams JW. Comparative effectiveness of new oral anticoagulants and standard thromboprophylaxis in patients having total hip or knee replacement: a systematic review. Ann Intern Med. 2013;159(4):275-284.