Author: Marco Propersi

The MICHELLE Trial: Anticoagulation Post-Discharge in Patients Hospitalized Secondary to COVID-19

Background:Patients diagnosed with COVID-19 have an increased risk of thromboembolic events, including pulmonary embolism and deep vein thrombosis (DVT). In addition, COVID-19 patients with increased coagulation parameters such as D-dimer, fibrin degradation products, prothrombin time, and activated partial thromboplastin time are at higher risk of morbidity and mortality.
Several RCTs have investigated the benefit of anticoagulation in patients with COVID-19 in various clinical settings. The INSPIRATION Trial investigated outcomes with an intermediate vs. standard prophylactic dose of anticoagulation in ICU patients. A multiplatform trial and HEP-COVID Trial investigated therapeutic anticoagulation in critically ill and non-critically ill hospitalized patients. The ACTIV-4B Trial investigated anticoagulation in symptomatic COVID-19 patients who did not require hospitalization. Currently, there is some evidence in support of therapeutic anticoagulation in non-critically ill hospitalized patients. However, there is no evidence to support the use of full dose anticoagulation in either the ICU or outpatient setting.

READ MORE

The ACTIV-4b Trial: Antithrombotics For Treatment of Outpatient COVID-19

Background: Severely ill patients diagnosed with COVID-19 have an increased risk of cardiovascular complications, especially thromboembolic events (Bikdeli 2020). The overall incidence of developing venous thromboembolism (VTE) is approximately 17% in patients diagnosed with COVID-19, with a significantly higher rate in the ICU setting (Jiménez 2021). Multiple studies have investigated the use of antithrombotic agents in patients with COVID-19 admitted to various hospital settings (Talasaz 2021). Some of these papers have been reviewed on REBEL EM. However, there is currently no evidence to support the use of antithrombotics in stable patients who are treated in the outpatient setting. Some clinicians have extrapolated inpatient data and are using antithrombotics in the outpatient setting without evidence. How should we manage those symptomatic but stable patients with COVID-19 that are discharged home without an inpatient stay? Investigators of the ACTIV-4b trial sought to answer this question.

READ MORE

PECARN Blunt Abdominal Trauma: Is A Clinical Decision Instrument Better Than Clinician Gestalt?

This post first appeared on REBEL EM Blog. Background: Unintentional injuries remain the leading cause of mortality in children. While traumatic brain injuries and thoracic traumas are the top two causes of mortality and morbidity, abdominal traumas are the third most common cause. Additionally, children are at higher risk for clinically significant intra-abdominal (IAI) injuries as a result of their anatomy in comparison to adults. Therefore, it is critical that emergency clinicians accurately diagnose IAI that requires intervention. Given the sensitivity of abdominal CTs for detecting IAI, emergency clinicians may be susceptible to overuse. Unfortunately, CTs expose patients to high doses of ionizing radiation, placing children at increased risk of developing radiation-induced malignancies. The data now shows that solid organ cancers occur in one out of every 300 to 390 girls and one out of every 670 to 690 boys undergoing abdominal CT.

READ MORE

Antacid Monotherapy vs GI Cocktail: Are You On or Off the Wagon?

This post first appeared on REBEl EM blog. Background: Dyspepsia and epigastric pain are common emergency department (ED) complaints affecting one in four adults annually. Twenty percent of these patients have an organic cause while 80% have functional dyspepsia (Moayyedi 2017). Antacids are often a first-line treatment in relieving the discomfort of dyspepsia and epigastric pain (Salisbury 2021). Antacids can be paired with other medications to create the “GI cocktail.”

READ MORE