Last Week in Medicine

Today I do a quick review of the COVID-19 thrombosis literature from the last year to try to answer some of the following questions: Why does COVID-19 cause thrombosis?  How many patients with COVID-19 develop thrombotic complications?  Why do patients with COVID-19 on VTE prophylaxis still develop blood clots?  Should we use intermediate dosing of anticoagulation for prophylaxis?  What about full dose therapeutic anticoagulation (no!) What do the guidelines say? Lots of papers:JAMA IM Review Autopsy Findings and VTE in Patients with COVID-19Klok et al Helms et alShah et alPiazza et alPorfidia et alKunutsor et alDutt et alStessel et alParanjpe et alFraisse et alMusoke et alPatel et alISTH GuidelinesACCP GuidelinesTake home points:COVID-19 is associated with an elevated risk of thrombosis. Observational data suggests that ICU patients are likely to develop thrombotic complications even on standard VTE prophylaxis.  This number seems to be round 25%.  Ward patients are also at higher risk (around 8-9%). Critically ill patients commonly develop heparin resistance, and this may partially explain why some patients with COVID develop thrombotic complications despite prophylaxis. Some have suggested intermediate dosing of anticoagulation for prophylaxis, but there are no randomized controlled trials published at this time, and observational data are limited. Some have suggested therapeutic dosing of anticoagulation for critically ill patients, but observational data show high rates of bleeding and other complications, and the three largest randomized controlled trials have stopped enrolling critically ill patients into the therapeutic anticoagulation arm due to safety concerns and futility. Some have suggested targeting a certain anti-Xa activity level, but no one really knows what that should be, and there aren’t any guidelines recommending it. ISTH and ACCP have both put out guidelines which are overall pretty similar.Make sure your patient has VTE prophylaxis, preferably a LMWH, and keep an eye out for thrombotic complications so you can treat them in a timely manner.  Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we have special guest Dr. Valerie Vaughn to talk about her new paper in Open Forum Infectious Diseases about inappropriate treatment and testing for asymptomatic bacteriuria.  Then we talk about the new ACTT-2 trial results of baricitinib plus remdesivir for COVID-19.  We also review the BioNTech/Pfizer vaccine safety and efficacy results, a noninvasive respiratory protocol to reduce intubations in COVID-19, and iron deficiency in acute heart failure. Testing and Treating Asymptomatic Bacteriuria Initiated in the EDBaricitinib Plus Remdesivir for COVID-19 (ACTT-2 trial)Safety and Efficacy of the BNT162b2 mRNA Covid-19 VaccineNon-invasive respiratory protocol for COVID-19Ferric Carboxymaltose for Acute HFrEF and Iron DeficiencyMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we have special guests Dr. Claire Ciarkowski and Dr. Stacy Johnson to talk about two recent papers they published, as well as the new SOLIDARITY trial results.  Are patient outcomes the same for resident, APC and solo hospitalist teams?  How do you get doctors to switch to oral antibiotics faster when treating pneumonia?  And with the new SOLIDARITY results showing no benefits for remdesivir, should we still be using it for COVID-19? Resident, APC and Solo Hospitalist Team OutcomesRapid Conversion to Oral Antibiotics for PneumoniaSOLIDARITY trial for COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

We're back with our second episode of the new season.  Dr. Rupp is sporting a new mustache, and we discuss the mysterious monolith discovered in the Utah desert.  If you want to skip the banter, go to 6:56. This week we try to figure out what that Danish Mask Study really showed.  Is it safe to use rivaroxaban in patients with a bioprosthetic mitral valve and A fib?  Does convalescent plasma improve outcomes in COVID-19?   Danish Mask StudyCDC Report on Kansas Mask MandatesRivaroxaban for A fib and Bioprosthetic Mitral ValveConvalescent Plasma for COVID-19Semaglutide and NASHWeekly Icodec InsulinStatin Nocebo EffectMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

We're back after a prolonged hiatus, ready to break down the latest and greatest in the medical literature.  Today's episode will get you caught up on the newest treatments for COVID-19.  We promise to talk about something else next time :) If you want to skip all the banter about Baby Yoda and politics, go to 8:36. Remdesivir for COVID-19 Final ReportTocilizumab for Hospitalized COVID-19 PatientsBamlanivimabPfizer VaccineModerna VaccineMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we are joined by a special guest, Dr. Lawanda Jim, chief of internal medicine at Northern Navajo Medical Center, to talk about what it's been like taking care of patients during the pandemic in Shiprock, NM.  Check it out! Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Today we're back with a spirited discussion of a pre-print publication for the dexamethasone arm of the RECOVERY trial.  Should hospitalized COVID19 patients receive dexamethasone?  Take a listen and decide for yourself. Dexamethasone in Hospitalized Patients with COVID-19Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

We're back with another episode.  We cover the latest highlights in COVID, including the exciting new results on remdesivir from the ACTT-1 trial.  We also talk about whether you can use CRP to guide duration of antibiotic therapy in patients with gram negative bacteremia, and whether NT-pro-BNP can help you risk-stratify patients with syncope.  Check it out! Remdesivir Shortens Time to Recovery in COVID19 (ACTT-1)CRP Guided Antibiotics or 7 Days vs 14 Days for Gram Negative Bacteremia NT-pro-BNP in SyncopeMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

We're back with some of the latest updates on COVID-19!  Are hydroxychloroquine or azithromycin associated with increased risk of mortality or cardiac arrest?  Does triple combination antiviral therapy shorten time to a negative viral swab?  Does remdesivir shorten time to clinical improvement?  Should we be giving patients convalescent plasma?  If you were the patient with severe COVID-19, which therapies would you want?Hydroxychloroquine and Azithromycin in New York CityTriple Combination Therapy for COVID-19 in Hong KongRemdesivir in adults with Severe COVID-19Treatment of 5 Patients with Convalescent PlasmaMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Dylan Sings Quarantine by Raffihttps://www.youtube.com/watch?v=xeEBcmkcJm8Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

It's been a while!  We took a short hiatus while our lives were upended by the pandemic.  But we couldn't stay away forever.  Today we review some of the big trials published in the last month on Covid-19.  We look at the large case series on New York patients published in JAMA, three hydroxychloroquine studies, the lopinavir-ritonavir study and the compassionate use of remdesivir study.  Buckle up! 5700 Patients Hospitalized with COVID-19 in New York CityLopinavir-Ritonavir in Severe COVID-19Hydroxychloroquine in FranceHydroxychloroquine in China Hydroxychloroquine in Veterans Compassionate Use of Remdesivir Music from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R