The Curbsiders Internal Medicine Podcast #393 Live from SHM: Clinical Updates in Hospital Medicine
May 1, 2023
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LMWH Beats Aspirin For Arthroplasty VTE
- The CRISTAL/aspirin vs LMWH perioperative trials showed LMWH yielded lower symptomatic VTE than aspirin monotherapy after hip/knee arthroplasty.
- Aspirin failed noninferiority and had higher VTE (1.8% vs 3.5%).
Tailor VTE Prophylaxis By Risk
- Risk-stratify orthopedic patients rather than reflexively using aspirin monotherapy for VTE prophylaxis.
- Prefer LMWH for higher-risk patients until larger trials (EPCAT3, PEPPER) clarify optimal strategies.
Periop Gabapentin Raises Delirium Risk
- Postoperative gabapentin in older adults associated with increased delirium, antipsychotic use, and pneumonia in a large retrospective cohort.
- The study found a ~30% relative increase in delirium (3.4% vs 2.6%).